EPA Form No. 5900

- 341

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017



## United States Environmental Protection Agency

Air Quality Permit by Rule for New or Modified True Minor Sources of

Air Pollution in Indian Country

http://www.epa.gov/air/tribal/tribalnsr.html

Notification of Coverage: Petroleum Dry Cleaning Facilities Page 1 of 10

Version 1.0 

## Notification of Coverage under the Air Quality Permit by Rule for New or Modified

True Minor Source Petroleum Dry Cleaning Facilities in Indian Country

Last Modified: March 2 3 , 2015

Version 1. 0

This Notification of Coverage under the Air Quality Permit by Rule for New or Modified True Minor Source Petroleum

Dry Cleaning Facilities in Indian Country applies to the construction of new, true minor source petroleum dry cleaning

facilitie s or the modification of existing, true minor source petroleum dry cleaning facilities in Indian c ountry . It applies

only to facilities that use 5,600 gallons or less of petroleum solvents annually in National Ambient Air Quality Standard

(NAAQS) ozone att ainment , unclassifiable or attainment/unclassifiable areas, or 1,300 gallons or less of petroleum

solvents annually in NAAQS ozone nonattainment areas

. A petroleum dry cleaning facility consists of dry cleaning dryers,

washers, filters, stills, settling tanks, and boilers.

You qualify to sub mit a Notification for Coverage u nder the Permit by Rule if you meet all of the

following criteria:

 Your new or modified true minor source petroleum dry cleaning facility is located within Indian Country;

 Your facilit y h a s a potential to emit (PTE) less than the New Source Review (NSR) major source thresholds;

 If located in an ozone attainment , unclassifiable or attainment/unclassifiable area, after the proposed

construction or modification project, the projected total usage of petroleum solvents at your facility will not

exceed 5,600 gallons per year based o n a 12

- month rolling total ;

 If located in an ozone nonattainment area, after the proposed construction or modification project, the

projected total usage of petroleum solvents at your facility will not exceed 1,300 gallons per year based o n a

12

- month rolling total ;

 You do not use fuels other than natural gas, propane, and butane in the fuel combustion units at your

facility;

 Th e maximum heat input capacity of each fuel combustion unit is less than 10 MMBtu/h ou r;

 The total heat input capacity of the fuel combustion units at your facility is eq ual to or less than 30

MMBtu/h ou r ;

 The capacity of any volatile organic liquid storage t ank at your facility does not exceed 19,812 gallons;

 Y o u de m o n s t r a t e , and obtain confirmation from the U.S. Environmental Protection Agency (EPA)

, t h a t yo u

have followed the screening process the EPA has provided w i t h re s p e c t t o t h e p r o t e c t i o n o f s p e ci es t ha t a re

feder all y

- li s t ed a s threatened or e n d an gered u n der t h e E n d an gered S p e ci es A c t (ESA) o r o f habi t a t t ha t i s

feder all y

- de s i g na t ed a s “c r i t ic a l hab i t a t ” u n der t h e E S A; and

 Yo u de monstrate, and obtain written confirmation from the EPA, that you followed the screening process to

address any effects to historic properties eligible for protection under the National Historic Preservation Act

(NHPA)

.

The reviewing authority retains dis cretion to terminate your coverage under the P ermit by R ule and require a source

specific permit even if the above criteria are met. Reasons t he reviewing authority may terminate a permitted source’s

coverage under the P ermit by R ule include :EPA Form No. 5900

- 341

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Notification of Coverage: Petroleum Dry Cleaning Facilities Page 2 of 10

Version 1.0 1. The permitte e is not in compliance with the provisions of the P ermit by R ule ;

2. The reviewing authority determines that the emissions resulting from the construction or modification of the

permitted source significantly contribute to NAAQS violations, which are not ade quately addressed by the

requirements in the P ermit by R ule;

3. The reviewing authority has reason to believe that the permittee obtained c overage under the P ermit by R ule by

fraud or misrepresentation ; or

4. The permittee failed to disclose a material fact required by the Notification of Coverage or the regulations

applicable to the permitted source of which the applicant had or should have had knowledge at the time the

permittee submitted the Notification of Coverage.

More Information

Information on the definition of a “modification” and “PTE” can be found at 40 CFR 49.152(d) and in the “Instructions”

document. Additional information on the applicability of the Federal Indian Country Minor NSR Rule can be found at 40

CFR 49.153.

Information on the ozone attainment status of the area where your facility is located can be found at:

http://www.epa.gov/airquality/greenbook/ . You may also contact your rev iewing authority for information on the

area’s attainment status.

Sources eligible for the Air Quality Permit by Rule for New or Modified True Minor Source Petroleum Dry Cleaning

Facilities may also be subject to federal standards under 40 CFR 6 0 Subpart JJ J

, Standards of Performance for Petroleum

Dry Cleaners . The conditions applicable to sources seeking coverage under this Permit by Rule are intended to be

generally consistent with the requirements in Subpart JJ J . However, compliance with the ap plicable requirements in

Subpart JJ J is required independent of the conditions in the Permit by Rule, and not all requirements applicable under

Subpart JJ J are necessarily included in the Permit by Rule. The Background Document for the Permit by Rule ident ifies

the specific requirements in Subpart JJ J that are intended to be included in the Permit by Rule. In addition, information

regarding the major federal regulations affecting petroleum dry cleaners is available here:

http://www.epa.gov/dfe/pubs/garment/frapc/petrfact.htm

.

Instructions

Step 1: Notify your reviewing authority, including providing appropriate documentation

, t h a t yo u (1) meet o n e o f t h e

c r i t er i a l i s t ed i n the EPA’s screening process for t h e p r o t e c t i o n o f an y an d al l s p e ci es t ha t a re feder all y

- li s t ed a s

threatened or e n d an gered u n der t h e ESA o r o f habi t a t t ha t i s feder all y

- de s i g na t ed a s “c r i t ic a l hab i t a t ” u n der t h e E S A;

and (2) satisfy the EPA’s screening process for the NHPA. You must obtain written confirmation from the EPA that the

threatened and endangered species and historic property screening procedures have been satisfied prior to submitting

your Notification of Coverage under th e Permit by Rule.

Step 2: After receiving notification that you have successfully met the requirements of Step 1, c omplete all sections of

the Notification of Coverage under the Permit by Rule (i.e., pages 4

– 10) . If you have questions, please contact the

reviewing authority

.

Step 3 : Certify that your existing or proposed facility is/will be in compliance with the applicable requirements as stated

in 40 CFR 49. 16 3 and s ubmit a copy of this notification to the rev iewing authority and to the tribe in the area where the

source is locating

. Submittal of this notification form also satisfies the requirement that minor sources in Indian country

register with the EPA.EPA Form No. 5900

- 341

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Notification of Coverage: Petroleum Dry Cleaning Facilities Page 3 of 10

Version 1.0 After you submit the Notification of Coverage under the Permit by Rule to the r eviewing a uthority :

 You may commence construction of your new source or modification of your existing source under th e Permit by

Rule.

 Your reviewing authority may request additional information from you in order to verify you are eligible for the

Permit by Rule

.

Applicants are welcome to s end comments on the EPA’s need for th e information in this application , and any

suggested methods for minimizing respondent burden, including through the use of automated collection

techniques

, to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200

Pennsylvania Ave., NW, Washington, D.C. 20460. Include the O MB control number in any correspondence. Do not

send the completed form to this address.EPA Form No. 5900

- 341

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Notification of Coverage: Petroleum Dry Cleaning Facilities Page 4 of 10

Version 1.0 

## Notificat i on of Coverage under the Air Quality Permit by Rule for New or Modified

True Minor Source Petroleum Dry Cleaning Facilities in Indian Country

Last Modified: March 2 3 , 2015

Version 1.0

Prior to construction or modification, complete this application and submit it to your reviewing authority.

A list of reviewing authorities, their area of coverage, and contact information can be found in Attachment D to the Air

Quality Permit by Rule for New or Modified True Minor Source Petroleum Dry Cleaning Facilities in Indian Country or

visit: http://www.epa.gov/air/tribal/tribalnsr.html

.

For assistance with this notification please contact your reviewing authority.

For instructions on completing this notification please see the document “ Instructions f or Notification of Coverage

under the Air Quality Permit by Rule f or New o r Modified True Minor Source Petroleum Dry Cleaning Facilities in

Indian Country .”



### Section 1: Contact Information

1. Business Name : 2. Date :

3. Site Address : 4. County :

5 . Name of Operator at Site (if different from owner) : 6. Phone of Operator or Contact at Site (if different from

owner) :

7. Owner : 8. Telephone Number of Owner :

9. Owner’s Mailing Address : 10.Send all correspondence regarding this application to:

Company Name:

c /o:

Address:

11. A uthorized contact regarding this permit application:

Name:

Title:

Phone: Email:

FAX:EPA Form No. 5900

- 341

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Notification of Coverage: Petroleum Dry Cleaning Facilities Page 5 of 10

Version 1.0 

### Section 2: Facility and Technical Information for the Notification of Coverage under the Air Quality

Permit by Rule for New or Modified True Minor Source Petroleum Dry Cleaning Facilities in

Indian Country

12. This notification is for:

A new petroleum dry cleaning facility (please describe the proposed new source )

.

_______________________________________________________________________________________________

__________________

_________________________________________ ____________________________________

Modification of an existing petroleum dry cleaning facility. Please describe the modification below. T he definition

of “modification” can be found at 40 CFR 49.152(d), and in the “Instructions” document available for completing

this notification form.

_______________________________________________________________________________________________

___________________________________________________________ __________ __________________________

13. North American Industry Classification System/Standard Industrial Classification Code and/or description o f the

facility:

_______________________________________________________________________________________________

_______________________________________ ____________________ ________________________________ ____

14. Will your new or modified facility be located in a serious, severe, or extreme ozone nonattainment area?

Information on the ozone attainment status of the area where your facility is or will be located can be

found at: http://www.epa.gov/airquality/greenbook/

.

Yes No

If you answered ‘ Yes, ’ specify the classification of the ozone nonattainment area:

Marginal Moderate Serious Severe Extreme

15. Will the PTE of your new facility

, or the increase in potential emissions from your modified existing facility

, be

equal to or above the applicable minor NSR thresholds listed below for ANY of the listed pollutant s, both in tons

per year (t py) ? Emissions from your facility may be calculated using the PTE calculator available online at :

http://www.epa.gov/air/tribal/tribalnsr.html

. Be sure to include all new or modified emission units at your facility

.

Pollutant Attainment Area Nonattainment Area

Carbon Monoxide (CO) 10 tpy 5 tpy

Particulate Matter (PM) 10 tpy 5 tpy

Particulate Matter

(PM 10 ) 5 tpy 1 tpy

Particulate Matter

(PM 2.5 ) 3 tpy 0.6 tpy

Sulfur Dioxide (SO 2 ) 10 tpy 5 tpy

Nitrogen Oxides (NO X ) 10 tpy 5 tpyEPA Form No. 5900

- 341

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Notification of Coverage: Petroleum Dry Cleaning Facilities Page 6 of 10

Version 1.0 Pollutant Attainment Area Nonattainment Area

Volatile Organic

Compounds (VOC) 5 tpy 2 tpy

Yes No

If you answered ‘No,’ your source is exempt from the minor NSR program. Please contact your reviewing authority

to confirm that your facility will not need a permit. If you answered ‘Yes,’ continue on to the next question

.

16. If located in an attainment

, attainment/unclassifiable or unclassifiable area, will the PTE of your facility be

less than 250 tpy for PM, PM 10 , PM 2.5 , VOC, NO X , CO, and SO 2 ? Be sure to include all existing, new, and

modified emission units at your facility

.

Yes No

If you answered ‘No

, ’ your source does not qualify for the Permit by Rule . Please contact your reviewing

authority to apply for a site

- specific permit. If you answered ‘Yes

, ’ continue on to the next question.

17. If located in a nonattainment area, will the PTE of your facility for the particular nonattainment pollutant

be les s than the NSR major source thresho lds below for ALL pollutants? Be sure to include all existing,

new, and modified emission units at your facility

.

Pollutant Nonattainment Classification NSR Major Source Threshold

Ozone Marginal 100 tpy of VOC or NO X

Moderate 100 tpy of VOC or NO X

Serious 50 tpy of VOC or NO X

Severe 25 tpy of VOC or NO X

Extreme 10 tpy of VOC or NO X

PM 10 Moderate 100 tpy

Serious 70 tpy

CO Moderate 100 tpy

Serious 50 tpy

SO 2 , NO 2 , PM 2.5 No nonattainment classification 100 tpy

Yes No N/A

- Not located in any nona ttainment area

If you answered ‘No

, ’ your source does not qualify for the Permit by Rule . Please contact your reviewing

authority to apply for a site

- specific permit. If you answered ‘Yes’ or ‘N/A

, ’ continue on to the next question.EPA Form No. 5900

- 341

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Notification of Coverage: Petroleum Dry Cleaning Facilities Page 7 of 10

Version 1.0 18. Is your annual solvent usage less than the thresholds required under 40 CFR 49. 16 3 ?

Yes No

If no, your source does not qualify for a Permit by Rule under 40 CFR 49. 16 3 and you must obtain a site

- specific

permit from your reviewing authority

.

19. Is the maximum heat input capacity of each fuel combustion unit less than 10 MMBtu/h ou r and the total combined

heat input capacity of all fuel combustion units less than 30 MMBtu/h ou r?

Yes No

If you answered ‘No

, ’ your source does not qualify for the Permit by Rule under 40 CFR 49. 163 and you must

obtain a site

- specific permit from your reviewing authority

.

20. Do you agree to comply with all requirements of the Permit by Rule as stated in 40 CFR 49. 163 ?

Yes No

If you an swered ‘No

, ’ your source does not qualify for the Permit by Rule under 40 CFR 49. 163 and you must

obtain a site

- specific permit from your reviewing authority

.

21. Emission Units

Information regard ing the existing and planned emission units at your facility is required by 40 CFR 49.154

and 49.160. Please provide the information in the following table for each emission unit at the site that is

or will be owned, leased or operated by the applicant . Examples of potential emission units include

combustion units, volatile liquid storage tanks, and petroleum dry cleaning dryers.

For each emission unit, include supporting documentation for the PTE of each unit with your notification of

coverage. In a ddition, for existing units, include the most recent actual annual emissions. See 40 CFR

49.154(a)(2). (For more information on how to calculate actual emissions, go to:

http://www.epa .gov/air/tribal/tribalnsrcalculators.html .) As needed, please include any other relevant

information with your notification.EPA Form No. 5900

- 341

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Notification of Coverage: Petroleum Dry Cleaning Facilities Page 8 of 10

Version 1.0 

### List of Existin g and Planned Emission Units ( attach additional copies of this table as necessary) :

Unit ID # Description of Equipment and/or

Process Materials or Fuel

(attach material safety

data sheets for each

volatile liquid or

coating) Maximum

Capacity or

Production Rate Description of

Pollution Control

Equipment Operating

Schedule Existing, New

or Modified

(including

i nstallation

f or existing)EPA Form No. 5900

- 341

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Notification of Coverage: Petroleum Dry Cleaning Facilities Page 9 of 10

Version 1.0 

### Section 3: Information on Completing Screening Processes that Have Been Satisfied Prior to

Submitting a Notification of Coverage under the Air Quality Permit by Rule for New or Modified

True Minor Source Petroleum Dry Cleaning Facilities in Indian Country

22

. Threatened or Endangered Species

Have y o u obtained confirmation from the EPA t h a t yo u have satisfactorily completed the screening process

for t h e p r o t e c t i o n o f an y an d al l s p e ci es t ha t a re feder all y

- li s t ed a s threatened or e n d an gered u n der t h e E S A

o r o f habi t a t t ha t i s feder all y

- de s i g na t ed a s “c r i t ic a l hab i t a t ” u n der t h e E S A? If you answer ‘No

, ’ you cannot

gain coverage under the Permit by Rule

.

Yes No

23

. Historic Pr operties

Have y o u obtained confirmation from the EPA that you have satisfactorily complete d t h e s c ree nin g p r o c ess

t o de t e r m in e i f the construction, modification or operation of your new or modified true minor source of air

pollutants ha s t h e p o t e n t ia l t o ca u se effe c t s t o hi s t o r i c p r o p er t i e s (pursuant to the NHPA) ? If you answer

‘No

, ’ you cannot gain coverage under the Permit by Rule

.

Yes No



### Section 4: Additional Information a bout t his Air Quality Permit by Rule for New or Modified True

Minor Source Petroleum Dry Cleaning Facilities in Indian Country

This section provides inform ation on the sizes of sources in terms of emissions that are eligible for the Permit by Rule

. The emission limitations and standards in this permit are generally expected to ensure that source

- wide emissions are

below the rates shown in the following table:

Pollutant of

Concern Ozone

Nonattainment

Areas Ozone Attainment

,

Unclassifiable or

Attainment/Unclassifiable

Areas

VOC 7 tpy 25 tpyEPA Form No. 5900

- 341

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Notification of Coverage: Petroleum Dry Cleaning Facilities Page 10 of 10

Version 1.0 

### Applicant’s Statement (to be signed by the applicant)

I certify that this document and all attachments were prepared under my direction or supervision according to a system

designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my

inquiry of the person or persons who manage the system, or those persons d irectly responsible for gathering the

information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.



### Name: _____________________________Name: ____________________________Date:__________

(Signature) (Print or Type)



### Title: _____________________________________