EPA Form No. 5900

- 342

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017



## United States Environmental Protection Agency

General Air Quality Permit for New or Modified Minor Sources of Air

Pollution in Indian Country

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



## Request for Coverage under the General Air Quality Permit for New or Modified

Minor Source Hot Mix Asphalt Plants in Indian Country

Last Modified: March 2 3 , 2015

Version 1. 0

This request for coverage under the General Air Quality Permit for Minor Source Hot Mix Asphalt Plants in Indian

Country applies to the construction of new minor source hot mix asphalt plants or the modification of existing minor

source hot mix asphalt plants in Indian country that meet certain production limitations and fuel restrictions as

specified below

. A hot mix asphalt plant is a facility that manufactures hot mix asphalt by heating and drying

aggregate and mixing it with asphalt cements, and is c omprised only of any combination of the following activities:

dryers, liquid asphalt storage tanks, fuel oil storage tanks, auxiliary heaters (including hot oil heaters), material

storage handling and transfer systems, generators, storage bins/silos, stora ge piles, and haul roads. This general air

quality permit does not apply to asphalt plants that perform contaminated soil remediation

.

This permit is available in Indian country for use by true minor and synthetic minor sources

.

You qualify to apply for coverage under this General Permit if you meet all of the following criteria:

 You plan to construct a new true or synthetic minor source batch or drum hot mix asphalt plant OR you plan

to modify an existing minor source batch or drum hot mix asphalt plant;

 You are not planning to construct or modify a major source batch or drum hot mix asphalt plant ;

 Your new or modified minor source hot mix asphalt plant is located within Indian country;

 Your facility produces only hot mix asphalt;

 Your facility is not located in a severe or extreme ozone nonattainment area (facilities in these areas must

obtain a site

- specific permit) ;

 You use only natural gas, propane, distillate fuel and biodiesel in the dryer/mixer;

 The asphalt dryer/mixer at your facility is control led by a baghouse (fabric filter);

 Are located in an ozone attainment

, u nclassifiable or a ttainment/ u nclassifiable area, a marginal or moderate

ozone nonattainment area, or a serious ozone nonattainment area, and t he asphalt production rate at your new

or modified facility is equal to or less than 83,000 tons per month for a drum mix plant, or 27,000 tons per

month for a batch mix plant;

 If located in a serious nonattainment area for carbon monoxide, t he new or modified source’s asphalt

production rate is equal to or less than 33,000 tons per month for a drum mix plant

, or equal to or less than

11,000 tons per month for a batch mix plant ;

 You use only the following fuel(s) in the auxiliary heaters: natu ral gas, propane, distillate fuel and biodiesel;

 The total maximum heat input capacity of the auxiliary heaters (including hot oil heaters) is equal to or less

than 10 MMBtu/h ou r;

 You use only diesel, or biodiesel in the stationary engines/generators;

 If located in an attainment

, u nclassifiable or a ttainment/ u nclassifiable area for ozone or a marginal or

moderate nonattainment area for ozone

, the total liquid fuel usage for the generators and engines at your

new or modified facility is equal to or less than 12,500 gallons per month;

 If located in a serious ozone nonattainment area, the total liquid fuel usage for the generators and engines

at your new or modified facility is equal to or less than 5,2 0 0 gallons per month;

 Each asphalt storage tank and fuel storage tank has a maximum capacity less than 39,890 gallons;EPA Form No. 5900

- 342

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Request for Coverage: Hot Mix Asphalt Plants Page 2 of 24

Version 1.0  You a re seeking to co

- locate your facility with a stone quarrying, crushing and screening operation and

would like to limit combined emiss ions to less than 100 tons per year ( tpy ) for NSR

- regulated pollutants

.

Y ou must comply with Conditions 17

. and 20.b

. in the General Permit and t his option is not available in

serious, severe, or extreme ozone nonattainment areas and serious carbon monoxid e ( CO ) nonattainment

areas

. S ource s in these areas would have to seek a site

- specific permit to obtain tighter limits to further

reduce their potential to emit ( PTE ) ;

 Y o u de m o n s t r a t e t h a t yo u meet o n e o f t h e c r i t er i a l i s t ed i n Appendix A 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 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 endangered 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

 Y o u have completed t h e s c ree nin g p r o c ess i n A pp e n d i x B t o de t e r m in e i f the construction, modification or

operation of your new or modified 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 National Historic Preservation Act (NHPA))

.

The reviewing authority retains discretion to terminate your coverage under the G eneral P ermit 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 G e neral P ermit include :

1. The permittee is not in compliance with the provisions of the General p ermit ;

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 adequately addressed by the

requirements in the G eneral P ermit ;

3. The reviewing authority has reason to believe that the permittee obtained c overage under the G eneral P ermit

by fraud or misrepresentation ; or

4. The permittee fa iled to disclose a material fact required by the Request for 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 Request for Coverage

.

More Information

This General Air Quality Permit for New or Modified Hot Mix Asphalt Plants in Indian Country is not applicable to:

 Facilities that perform contaminated soil remediation ;

 Facilities that produce cold mix asphalt ; and

 Facilities located in seve re or extreme ozone nonattainment areas

.

If your hot mix asphalt facility is co

- located with another source, and the potential to emit of the combined source is

less than the major source thresholds for any NSR

- regulated pollutant, you may qualify for cov erage under this

General Permit.

Information on the definition of a “modification” and potential to emit or “PTE” can be found at 40 CFR 49.152(d)

and in the “Instructions” document. Additional information on the applicability of the Federal Indian Count ry 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 reviewing authority for information on the

area’s attainment status.EPA Form No. 5900

- 342

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Request for Coverage: Hot Mix Asphalt Plants Page 3 of 24

Version 1.0 Sources eligible for the General Permit for New or Modified Minor Source Hot Mix Asphalt Plants may also be subject to

federal standards under 40 CFR 60 Subpart I

– Standards for Performance for Hot Mix Asphalt Facilities, 40 CFR 60

Subpart IIII

– S tandards of Performance for Stationary Compression Ignition Internal Combustion Engines , and 40 CFR 63

Subpart ZZZZ

– N ational Emissions Standards for Hazardous Air Pollutants for Stationary Reciprocating Internal

Combustion Engines . The conditions applicable to sources seeking coverage under this General Permit are intended to

be generally consistent with the requirements in these regulations; however, complianc e with the applicable

requirements is required independent of the conditions in the General Permit , and not all requirements applicable

under Subparts I, IIII, and ZZZZ are necessarily included in the General Permit . The Background Document for the

General Permit identifies the specific requirements in these Subparts that are intended to be included in the General

Permit

.



### Instructions

Step 1: Complete all sections of the permit application. If you have questions, please contact the reviewing authority

.

Step 2: Submit a copy of this permit application to the reviewing authority and the tribe in the area where the source is

locating or being modified

.



### After you submit the application to the r eviewing a uthority :

 You may not commence construction of your new source or modification until you receive notification of the final

decision on your application for coverage under this General Permit

.

 Your r eviewing authority will act on your permit as expeditiously as possible, and will notify you if more

i nformation is needed in writing within 30 days from receipt of your application. Upon deeming the application

complete, and if any additional information requested by the reviewing authority is received within 15 days of

the request, the reviewing authorit y will follow the procedures outlined in 40 CFR 49.156(e) and your permit

application will be granted or denied no later than 90 days after the receipt of your coverage request.

 Your reviewing authority will send you a letter notifying you of the approval or denial of your request for

coverage under this General Permit if the reviewing authority determines that your request for coverage under

this General Permit has all the relevant information and is complete. Such a letter is a final permit action for

pu rposes of judicial review only for the issue of whether your source qualifies for this General Permit

.

Applicants are welcome to s end comments on the U.S. Environmental Protection Agency’s (EPA’s) ne ed 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 (282 2T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any

correspondence. Do not send the completed form to this address.EPA Form No. 5900

- 343

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017



## United States Environmental Protection Agency

General Air Quality Permit for New or Modified Minor Sources of Air

Pollution in Indian Country

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



## Request for Coverage under the General Air Quality Permit for New or Modified

Minor Source Hot Mix Asphalt Plants 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

General Air Quality Permit for Minor Source Hot Mix Asphalt Facilities or visit:

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

.

For assistance with this application please contact your reviewing authority.

For instructions on completing this application please see the document “Instructions for Requesting Coverage

under the Genera l Air Quality Permit for New or Modified Minor Source Hot Mix Asphalt Plants i n 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

- 342

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Request for Coverage: Hot Mix Asphalt Plants Page 5 of 24

Version 1.0 

### Section 2: Facility Information for Requesting Coverage under the General Air Quality Permit for

New or Modified Minor Source Hot Mix Asphalt Plants

12. Please list all of the site locations for which you want approval to locate your hot mix asphalt plant . Include the

site name (if any), street address, city, state, and name of the Indian Reservation. If needed, use additional paper.

You may seek approval for additional locations in the future.

Site Name Street Address City/ T own Area of Indian

Country

13. This application is for (check all that apply) :

Construction/Relocation of a n ew h ot m ix a sphalt f acility in Indian country

– no current general permit (please

describe the proposed new source or location )

.

_____________________________________________________________________ ___________________ _____

____________________________________________________________ ______________________ ___________

Add a new location for your h ot m ix a sphalt f acility already covered by the General Permit (please describe the

proposed new location)

.

_____________________________________________________________________ ___________________ ___ __

____________________________________________________________ ______________________ ___________

Modification of an existing hot mix asphalt facility . Please describe the modification below. The definition of

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

.

_____________________________________________________________________ ___________________ _____

__________________ ____________________________________________ ______________________ _________

A hot mix asphalt operation co

- located with a stone quarrying, crushing, and screen ing operation and seeking to

limit combined emissions to less than 100 tpy for NSR

- regulated pollutants

. You must comply with Conditions 17

. and 20.b

. in the General Permit . This option is not available in serious , severe and extreme ozone nonattainment

areas and serious CO nonattainment areas (please describe the proposed source)

.

_____________________________________________________________________ ___________________ _____

______________________________________________________________ ______________________ _________EPA Form No. 5900

- 342

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Request for Coverage: Hot Mix Asphalt Plants Page 6 of 24

Version 1.0 1 4

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

facility:

_______________________________________________________________________________________________

___________________________________________________________ ________________________________ ____

1 5

. Type of Asphalt Plant: (check all that apply):

Stationary Portable Batch Mix Parallel Flow Drum Mix Counterflow Drum Mix

1 6

. Will your new or modified f acility be located in an ozone nonattainment area? Information on the ozone

attainment status of the area where your facility is /will be located can be found at:

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

Yes No

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

Marginal Moderate Serious Severe Extreme

Note: If your facility will be located in severe or extreme ozone nonattainment area, it does not qualify

for this General Permit and you must obtain a site

- specific permit from the reviewing authority

.

1 7

. Will your new or modified facility be located in a particulate matter ( PM 10 ) nonattainment area? Information on

the 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 PM 10 nonattainment area:

Moderate Serious

1 8

. Will your new or modified facility be located in a particulate matter ( PM 2 .5 ) nonattainment area? Information on

the 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

1 9

. Will your new or modified facility be located in a carbon monoxide ( CO) nonattainment area? Information on the

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 CO nonattainment area:

Moderate SeriousEPA Form No. 5900

- 342

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Request for Coverage: Hot Mix Asphalt Plants Page 7 of 24

Version 1.0 20

. 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 tpy ?

Emissions from your facility may be calculated using the 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

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 tpy

Volatile Organic

Compounds (VOC) 5 tpy 2 tpy

Yes No

If you answered ‘No,’ your source is likely exempt from the minor NSR program. Please contact your reviewi ng

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

question.

21. 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 , each individually? Be sure to include all

existing, new, and modified emission units at the facility

.

Yes No

If you answered ‘No

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

a uthority to apply for a site

- specific permit. If you answered ‘Yes

, ’ continue on to the next question.

22

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

be less than the NSR major source thresholds below for ALL pollutants? Be sure to include all existing,

new, and modified emission units at the 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 XEPA Form No. 5900

- 342

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Request for Coverage: Hot Mix Asphalt Plants Page 8 of 24

Version 1.0 Pollutant Nonattainment Classification NSR Major Source Threshold

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 no nattainment area

If you answered ‘No

, ’ your source does not qualify for the General Permit . Please contact reviewing authority

to apply for a site

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

, ’ continue on to the next question.

2 3 . Projected asphalt production rate after construction/modification/reloca tion:

Tons/ month : _____________

2 4 . Does or will this facility perform contaminated soil remediation?

Yes No

If you answered ‘Yes’ to this question, your facility does not qualify for a general permit and you must

obtain a site

- specific permit from your reviewing authority

.



### Section 3: Technical Information for Requesting Coverage under the General Air Quality

Permit for New or Modified Minor Source Hot Mix Asphalt Plants

Information regarding the emission units at your facility is required by 40 CFR 49.154 and 40.160. Please

provide th e information below for all equipment at your facility. For each emissions unit, include supporting

documentation for the PTE of the unit with your Request for Coverage. In addition, for existing emissions units,

include the most recent actual annual emiss ions. See 40 CFR 49.154(a)(2). (For more information on how to

calculate actual emissions, you may go to: http://www.epa.gov/air/tribal/tribalnsrcalculators.html .) As needed,

please include other relevant information with your notification (including any equipment not identified

below)

.

Dryer

2 5 . Dryer ID:

_________________

2 6 . Construction/Modification Date of the Dryer (mm/dd/yyyy; actual or anticipated): _________________

2 7

. Dryer Burner Capacity (MMBtu/h ou r): _____________________EPA Form No. 5900

- 342

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Request for Coverage: Hot Mix Asphalt Plants Page 9 of 24

Version 1.0 2 8 . Fuel(s) Used in the Dryer:

Natural Gas Propane Distillate Fuel Biodiesel

29 . Is the dryer/mixer controlled by a baghouse ( f abric f ilter) or venturi scrubber ?

Yes No

If you answered No to this question, your facility does not qualify for a general permit and you must

obtain a site

- specific permit from reviewing authority

.

3 0

. Internal Combustion Engines (including emergency generators)

Unit ID

# Unit Description Maximum Rated

Capacity (HP) Types of Fuel(s)

Used 1 Manufactured

Date

(mm/dd/ yyyy ) Model

Year

3 1

. Auxiliary Heaters

Unit ID

# Unit Description Maximum Heat

Input Capacity

(MMBtu/h ou r) Types of Fuel(s)

Used 2 Construction

Date

(mm/dd/yyyy)

Total Heat Input Capacity : 3

1 Only diesel fuel or biodiesel are allowed in this General Permit

.

2 Only natural gas, propane, dist illate fuel and biodiesel are allowed in this General Permit

.

3 In order to qualify for this General Permit , the total heat input capacity of the auxiliary heaters cannot exceed 10 MMBtu/hour.EPA Form No. 5900

- 342

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Request for Coverage: Hot Mix Asphalt Plants Page 10 of 24

Version 1.0 3 2

. Material Handling, Transferring, Loading, and Storage Equipment

Unit ID

# Unit Description Maximum

Capacity

(ton/hour) Construction Date

(mm/dd/yyyy) Type of Control

(if any)

3 3

. Volatile Liquid Storage Tank s

This section applies to storage tanks used to store liquid materials. Please provide the following information for

each s torage t ank.

Unit ID # Type of

Liquid Capacity

(gallons) Vapor pressure

of liquid ( psi ) Is the tank above

or underground? Date of

installation (if

existing)EPA Form No. 5900

- 342

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Request for Coverage: Hot Mix Asphalt Plants Page 11 of 24

Version 1.0 

### Section 4: Information on Completing Screening Processes that Have to Be Satisfied to Request

Coverage under the General Air Quality Permit for New or Modified Minor Source Hot Mix Asphalt

Plants

3 4

. Threatened or Endangered Species

Have y o u de m o n s t r a t ed t h a t yo u meet o n e o f t h e c r i t er i a l i s t ed i n Appendix A 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 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 endangered 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 answered ‘ No, ’ you cannot

request coverage under this permit.

Yes No

If you answered ‘ Yes, ’ then you need to provide the appropriate documentation to the EPA to qualify for

coverage under this permit. Please indicate under which c riterion in Appendix A you are satisfying this

requirement:

A B C D E

3 5

. Historic Pr opert ies

Have y o u completed t h e s c ree nin g p r o c ess i n A pp e n d i x B t o de t e r m in e i f the construction, modification or

operation of your new or modified 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 answered ‘ No, ’ you cannot request coverage under this permit.

Yes No

If you answered ‘ Yes, ’ then provide the appropriate documentation to the EPA to qualify for coverage

un der this permit

.



### Section 5: Additional Information a bout t his General Air Quality Permit for New or Modified

Minor Source Hot Mix Asphalt Plants

This section provides information on the sizes of sources in terms of emissions that are eligible for the General Permit

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

- wide emissions are below the

rates shown in the following table:

Pollutant of

Concern Attainment , U nclassifiable or

Attainment/Unclassifiable

Areas Nonattainment Areas

CO 8 0 tpy 8 0 tpy

(moderate areas)

40 tpy

(serious areas)

PM 10 26 tpy 26 tpy

(moderate areas)

26 tpy

(serious areas)

PM 2.5 14 tpy 14 tpyEPA Form No. 5900

- 342

EPA ICR No. 1230.27

OMB Control No. 2060

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Approval expires 4/30/2017

Request for Coverage: Hot Mix Asphalt Plants Page 12 of 24

Version 1.0 Pollutant of

Concern Attainment , U nclassifiable or

Attainment/Unclassifiable

Areas Nonattainment Areas

SO 2 18 tpy 18 tpy

NO X 71 tpy 71 tpy

(marginal and moderate ozone areas)

45 tpy

(serious ozone areas )

VOC 28 tpy 28 tpy

(marginal and moderate ozone areas)

18 tpy

(serious ozone areas)

For a hot mix asphalt operation co

- located with a stone quarrying, crushing, and screening operation

, the emission

limitations and standards in Conditions 17

. and 20.b of the General Permit are expected to ensure the source

- wide

emissions are below the rates shown in the following table:

Pollutant of

Concern Attainment , U nclassifiable or

Attainment/Unclassifiable

Areas Nonattainment Areas

CO 78 tpy 78 tpy

(moderate areas)

Not applicable

(serious areas)

PM 86 tpy Not applicable

PM 10 6 3 tpy 6 3 tpy

(moderate areas)

6 3 t py

(serious areas)

PM 2.5 30 tpy 30 tpy

SO 2 18 tpy 18 tpy

NO X 90 tpy Not applicable

(serious and above ozone areas)

90 tpy

(marginal and moderate ozone areas)

VOC 2 7 tpy Not applicable

(serious and above ozone areas)

27 tpy

(marginal and moderate ozone areas)

You should contact your reviewing authority if you intend to rely on the emission limitations and standards in this

General Permit to prevent hav ing to obtain a Title V permit.EPA Form No. 5900

- 342

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Request for Coverage: Hot Mix Asphalt Plants Page 13 of 24

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 directly responsible for gathering the

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



### Name: _____________________________Name: ____________________________Date:__________

(Signature) (Print or Type)



### Title: _____________________________________EPA Form No. 5900

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OMB Control No. 2060

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Approval expires 4/30/2017

Request for Coverage: Hot Mix Asphalt Plants Page 14 of 24

Version 1.0 

## A pp e n d i x A

– Threatened or E n da n g e r ed S p ec i es R e q ui r e m en t s

T h e p u r p os e o f t hi s appendix i s t o a s s i s t y o u i n completing t h e screening procedure for addressing threatened or

endangered species prior to submitting your request for coverage under a General Air Quality Permit for New or

Modified Minor Source Hot Mix Asphalt Plants in Indian Country

. I n o rder t o b e e l i g ibl e f o r c o ver a ge u n d e r the General

Permit

, y o u must de m o n s t r a t e t h a t yo u qualify under o n e o f t h e c r i t er i a l i s t ed i n t h i s app e n d ix 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 endangered 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.

T hi s appendix p r o v i des y o u in f o rm a t i o n o n t h e f o ll o w in g:

• Section 1.0: Listed Species Eli g ibil i t y C r i t er ia and

• Section 2.0: G u i d anc e f o r D e t erm inin g Whic h Listed Species C r i t er i on A ppli es

.



### 1.0 Listed Species Eli g i b ility Cr ite r ia

To be eligible for coverage under the General Permit, y o u m u st obtain confirmation from the EPA that you completed

the screening procedure and meet o n e o f t h e e li g i bi l i t y c r i t er i a li s t e d b e l o w. Y o u m u s t al s o s p e ci fy i n your submittal t h e

ba s i s f o r y ou r s e l e c t i o n o f t h e applic a b l e e li g ib i l i t y c r i t er i o n and provide documentation supporting the criterion

selected

. If you have not obtained confirmation from the EPA regarding listed species eligibility criteria, you will not be

eligible for coverage under the General Permit, and you must apply for a site

- specific permit.

No t e : ( 1 ) Y o ur determination m us t p r o v i de sufficient d o c u me n t a t i o n t o s u pp o rt y o u r de t erm ina t io n t ha t yo u s a t i s fy t h e

r e q u i reme n t s o f t h e pa r t ic u la r c r i t er i o n you have selected

. ( 2 ) Whil e c oo rd ina t i o n b e tw een yo u an d t h e U

. S

. F i s h an d Wil d li fe

S erv ic e (FWS) an d / o r t h e N a t i o na l M a r in e F i s h er i es S erv ic e ( NMFS; t o ge t h er, t h e “ S erv i c e s ” ) i s n o t n e c es s a r il y re q u i red i n al l ca se s

, the EPA e nc o u r a ges y o u t o c o o rd ina t e w i t h t h e relevant Service ( s ) an d t o do s o e a r l y i n t h e plannin g p r o c e s s p r i o r t o s u b m i tt in g

you r notification of coverage

.

You must comply with any applicable terms, conditions, or other requirements developed in the process of meeting

any of the eligibility criteria (A

- E) in this section to remain eligible for coverage under the General Permit

. Documentation of these requirem ents shall be maintained by the pe r mittee for the duration of time the affected

emissions unit(s) is (are) covered under the General Permit

.

The following is a summary of the five eligibility criteria. See Section 2.0 for detailed instructions to dete rmin e which

criterion applies for your specific action:

Cr ite r ion A :

N o f eder all y

- li s t ed threatened or endangered s p e ci es o r des i g na t ed c r i t i c a l ha b i t a t ( s ) of such species a re lik e l y t o o c c u r

within the action area for your project

. 4

4 Action area means all areas to be affected directly or indirectly by your project and may be broader than the immediate

project area [ See, e.g.

, 50 CFR 402.02].EPA Form No. 5900

- 342

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Request for Coverage: Hot Mix Asphalt Plants Page 15 of 24

Version 1.0 Cr ite r ion B :

F eder all y

- li s t ed threatened or endangered s p e ci es o r t h e i r de s i g na t ed c r i t ica l habi t a t ( s ) a re lik e l y t o o c c u r within the action

area of your source , but the construction and operation of y o u r new minor source or construction and operation of the

modification to your existing minor source is n o t lik e l y t o a dverse l y a ff e ct li s t ed t h re a t e n ed o r e n d an gered s p e ci es o r

c r i t i c a l hab i t a t . T hi s de t erm ina t i o n m a y incl u de c o n s i der a t io n o f a n y air pollution c o n t r o l s or other changes to the

construction and/or operation of your new or modified source that yo u w il l a d o p t to e n s u re t ha t construction, modification

and operation of your new or modified source are n o t l ik e l y t o a dver s e l y a f fe c t li s t ed s p e ci es or c r i t ic a l hab i t a t. To

m ak e t hi s c ert i f ic a t i o n

, y o u m u st incl u de t h e f o ll ow in g i n you r request for coverage documentation : ( 1 ) identify any

feder all y li s t ed s p e ci es an d /o r d e s i g na t ed critical hab i t a t l o ca t ed within the action area of your source; ( 2 ) t h e d i s t a n c e

b e tw een you r s i t e an d t h e listed species or designated critical habitat (in miles); and (3) any other information

necessary (e.g., a detailed map of the action area and supporting justification ) to show that the

construction/modification and operation of your new or modified source are not likely to cause any adverse effects to the

listed threatened or endangered species or their critical habitat.

Cr ite r ion C :

C o o rd ina t i o n b et w een yo u an d t h e S erv ic e ( s ) ha s b een c o ncl u de d and has a ddre s sed t h e effe c t s o f y o u r new or

modified minor source’s construction/modification and operation o n fe d er all y

- li s t ed t h r e a t e n ed o r e n d an gered s p e ci es

an d feder all y

- d e s i g na t ed c r i t ica l hab i t a t

. The coordination m us t re s u l t i n a w r i t t en c o nc u rre nc e f ro m t h e re l ev an t

S erv ic e ( s) t h a t you r new or modified minor source’s construction/modification and operation a re n o t lik e l y t o a dver s e l y

a ffe c t li s t ed s p e ci es o r c r i t i c a l ha b i t a t

. Y o u m us t incl u de c o pi es o f t h e c o rre s p o n de nc e b e tw een y o u r s e l f an d t h e

S e r v ic e ( s ) with your submittal

.

Cr ite r ion D :

Co n s u l t a t i o n b et w een another F eder a l A ge n c y an d t h e Service(s) u n d e r s e c t i o n 7 o f t h e E S A ha s b een c o ncl u de d

. T h e

c o n s u l t a t i o n m us t ha ve a ddres s ed t h e effe c t s o f your minor source’s construction/modification and operation o n

feder all y

- li s t ed t h re a t e n ed o r e n d an ge r ed s p e ci es an d feder ally

- des i g na t ed c r i t ic a l hab i t a t

. T h e re s u l t o f t hi s

c o n s u l t a t i o n m us t b e e i t h er:

1. A bi o l o g ica l o pini o n t h a t c o ncl u des t ha t t h e a c t i o n i n q u e s t i o n ( t akin g i n t o acc ou n t t h e effe c t s o f y ou r

s ource’s construction/modification and operation) i s n o t lik e l y t o j e o pa rd i z e t h e c o n t in u ed ex i s t e nc e o f

li s t ed s p e ci e s

, o r result in t h e des t r u c t i o n o r a dverse m o d i f ica t i o n o f c r i t i ca l hab i t a t ; o r

2. Written c o nc u rre nc e f ro m t h e appl i cabl e S erv ic e ( s ) w i t h a f in d in g t h a t t h e source’s

construction/modification and operation a re n o t lik e l y t o a dver s e ly a ffe c t feder all y

- li s t ed s p e ci es o r

fed e r all y

- des i g na t ed critical habi t a t

.

Y o u m u st incl u de c o pi es o f t h e relevant documentation cited above i n y o u r submittal

.

Cr ite r ion E :

Y ou have obtained an incidental take permit from the Service(s) under section 10 of the ESA in connection with your

c o n s t r u c t i o n/modification and operation ac t i v i t i es, an d t hi s permit a ddres s e s t h e effe c t s o f t h e source o n relevant

feder all y

- li s t ed s p e ci es an d feder all y

- des i g na t ed c r i t i ca l hab i t a t

. Y o u m u st incl u de c o pi es o f t h e incidental take permit

and associated documentation and c o rre s p o n de nc e b e tw e e n y o u r s e l f an d t h e S erv i c e ( s ) with your submittal

.EPA Form No. 5900

- 342

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Request for Coverage: Hot Mix Asphalt Plants Page 16 of 24

Version 1.0 

### 2.0 De t e r mini n g W hich Cr ite r ion A pp lies

To qualify for the General Permit

, yo u need to m e et o n e o f t h e five c r i t er i a l i s t ed a b o ve . Y o u m u st f o ll o w t h e

p r o c ed u res i n S t e p s 1 t h r ou gh 5 below t o de t erm in e t h e listed species c r i t er i o n, if any, u n der w hic h y o u r project i s

e li g ibl e f o r p e r m i t c o ver a ge.

Step 1

- Determine if Previous or Separate Assessments Have Already Addressed Your Source

You should first determine whether you are eligible to select either Criterion D or E based on a n ESA section 7

consultation previously completed by another Federal Agency (Criterion D) or a n ESA s ection 10 permit (Criterion E)

issued by the Service(s) as follows:

Meeting Criterion D : If consultation under section 7 of the ESA has been concluded in connection with another Federal

Agency’s involvement with your source, you may be eligible to select Criterion D. To be eligible to select Criterion D, you

must confirm that all the following are true:

 A consultation between a Federal Agency and the Service(s) under section 7 of the ESA has been concluded.

Consultations can be either formal or informal, and would have occurred in connection with a separate action by

a separate Federal Agency (e.g., as part of a separate Federal Agency’s authorization for you to construct or

operate your business in Indian country). The consultation must have addressed the effects of the construction,

modification and operation of your new or modified source on all federally

- listed threatened or endangered

species and all federally

- designated critical habitat in your action area. The result of this consultation must be

either:

a. A biological opinion that concludes that the construction, modification and operation of your new or

modified source is not likely to jeopardize the continued existence of any listed species, nor result in the

destruction or adverse modification of any designated critical habitat. The consultation must have included

consideration of the ef fects of your facility’s emissions and other related activities on all listed species and

designated critical habitat in your action area; or

b. Written concurrence (e.g., letter of concurrence) from the applicable Service(s) with a finding that the

construc tion, modification and operation of your new or modified source are not likely to adversely affect

listed species or designated critical habitat. The consultation must have included the effects of your

facility’s emissions and other related activities on a ll the listed species and designated critical habitat in

your action area.

 The consultation remains current, in accordance with 50 CFR § 402.16; or, if re

- initiation of consultation is

required (e.g., due to a new species listing or critical habitat desig nation or new information), such reinitiated

consultation is concluded, and the result of the consultation is consistent with the statements above. Attach a

copy of any consultation re

- initiation documentation from the Service(s) or other consulting Federa l Agency.

I f all of the above are true, you may select Criterion D. You must also provide a description of the basis for the

criterion selected. In your submittal you must also provide the Biological Opinion (or Public Consultation Tracking

System tracking number) or concurrence letter and any other documentation supporting your determination.

If any of the above is not true, you may not select C riterion D. For example : if the biological opinion or written

concurrence from the Service(s) did not inc lude the effects of your source’s air emissions or other

- related activities as

described above ; or if the previous consultation covered some but not all of the listed species or critical habitat in your

action area ; or if the consultation is no longer curr ent (e.g., due to new species listings) ; then you are not eligible under

C riterion D.EPA Form No. 5900

- 342

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Request for Coverage: Hot Mix Asphalt Plants Page 17 of 24

Version 1.0 Meeting Criterion E : You have obtained an incidental take permit under section 10 of the ESA

, and this permit

addresses the effects of the construction/modification and operation of your new or modified source on federally

listed species and designated critical habitat in your action area.

You may rely on a section 10 permit that you have previously obtained so long as it addresses the

construction/modification and operation of your new or modified source and all federally

- listed species and

designated critical habitat in your action area

. (Note: If you do not hold a section 10 permit already, you can

consider obtaining one, however, it may be more efficient to inst ead meet the requirements for Criterion A, B or C

as described in Steps 2

– 5.)

If you choose to apply for a new section 10 permit, y o u m u s t f o ll o w applicable Service p r o c e d u res ( s ee 50 C F R §

1 7

. 2 2 ( b ) ( 1) f o r F W S an d § 22 2

. 22 f o r N M F S )

. A pplica t i o n in s t r u c t i o n s f o r s e c t i o n 10 p erm i t s f o r F W S a n d N M F S ca n b e

o b t ain ed b y acc e s s in g t h e F W S an d N M F S w e b s i t es ( h tt p : // www

. f w s

. g o v a n d h t t p : // www

. n mf s

. n o a a

. g o v ) o r b y

c o n t ac t in g t h e app r o p r ia t e F W S a n d N M F S reg i o na l o ff ic e

.

If the above is true, you may select C riterion E. You must also provide a description of the basis for the criterion

selected. In your submittal you must provide a copy of the permit issued by the Service ( s )

.

If the above is not true, you may not select C riterion E at this time and must proceed to Step 2

. For example, i f a

permit has been issued under section 10 of the ESA, but t he permit did not consider the effects of the facility’s air

emissions and/or emission

- related activities on all federally listed species and designated critical habitat on your

species list, you are not eligible under C riterion E.

Step 2

- De t erm in e i f L i s t ed T h re a t e n ed o r En d an gered S p e ci es o r t h e i r D e s i g na t ed C r i t ica l Ha b i t a t ( s ) a re L ik e l y t o

O cc u r within the Action Area of your Minor Source.

Y o u m u s t de t erm in e, t o t h e b e s t o f y o u r kn o w l edge, w h e t h er s p e ci es federally li s t ed a s e i t h er t h re a t e n ed o r

e n d an ge r ed, o r t h e i r designated c r i t ic a l hab i t a t ( s ), a re l o ca t ed within the action area of your minor source. 5 This is a two

step process. The first step is to determine your action area

. When defining the boundaries of your action area, you should

take into account the following criteria:

 Ground disturbance

– Effects during construction, maintenance and operation of the facility should be

considered.

 Changes in water quality/quantity (both surface and groundwater)

– This would include effects that may extend

far beyond the footprint of the facility. An examp le may be stormwater runoff from impervious surfaces

(containing sediments or other contaminants) on the site that may reach water bodies (including ditches that

empty into water bodies) some distance from a facility. All receiving water bodies that could receive pollutants

from the facility’s construction, maintenance, or operation should be included in the action area.

 Air Quality Impacts

– Effects during construction, maintenance and operation of the facility should be

considered.

 Lighting effects

– Eff ects during construction, maintenance and operation of the facility should be considered.

5 For definitions of terms that you might encounter when addressing the listed species requirements , go t o:

http://www.fws.gov/midwest/endangered/glossary/index.html and http://www.fws.gov/northeast/nyfo/es/actionarea.htm

.EPA Form No. 5900

- 342

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Request for Coverage: Hot Mix Asphalt Plants Page 18 of 24

Version 1.0  Noise Disturbance

– Effects during construction, maintenance and operation of the facility should be considered.

Note: If you have questions about determining the extent of the action area, you should coordinate with the

local Service field office as noted below. If site

- specific conditions exist such that the action area would be

limited to the facility footprint, but that fact may not be obvious from a map or figure, submit a narrative

description of the action area in addition to a map for evaluati on of the action area selected. To de t erm in e

t h e f i e l d o ff ic e t ha t c o rres p o n ds t o y ou r p r o je c t s i t e, v i s i t :

h t t p : // www

. f w s

. g o v / e n d an gered / reg i o n s / in de x

. h t ml an d h t t p : // www

. n mf s

. n o a a

. g o v/ ( un der t h e l eft t ab f o r

“ R eg i o n s ” )

.

After determining the boundaries of the action area, you will next de t erm ine i f li s t ed s p e ci es an d /o r c r i t ica l hab i t a t a re

ex p e c t ed t o ex i s t there. Relevant sources of information regarding the locations of listed species and critical habitats are

often organized along county and/or township lines. You should thus first identify the counties and/or townships within

which your action area is located. You would then consult relevant sources of information regarding the locations of listed

species and critical habitats. T h e l o ca l o ff ic es o f t h e F W S and N M F S o f t en m ain t a i n li s t s o f feder all y li s t ed threatened or

endangered s p e ci es o n t h e i r Internet si t es. Fo r F W S t erre s t r ia l a n d aq u a t i c s p e ci es in f o rm a t i o n

, y o u c a n u se the F W S o n

lin e m app i n g t oo l

, t h e I n f o rm a t i o n

, P lannin g, a n d Co n su l t a t i o n S y st em, l o ca t ed a t h t t p : // www

. f w s

. g o v / ipac /

.

I n m o st ca se s

, listed s p e ci es an d designated c r i t ica l hab i t a t li s t s will all o w yo u t o de t erm in e i f an y s u c h s p e ci es o r

habi t a t ex i s t s i n y o u r c o u n t y o r t o w n s h i p

. Yo u ca n al so f in d c r i t i ca l hab i t a t des i g na t i o n s an d a sso ci a t ed

re q u i reme n t s a t 50 CF R P a r t s 17 an d 22 6 (see h t t p : // www

. acc e s s

. g p o .g o v )

. You may also use the FWS Critical

Habitat Portal (see http://criticalhabitat.fws.gov/crithab/ ).

 I f t h e r e ar e n o li s ted sp e cies and/

or critical habitat in the coun t ies/ t o w n s hips where your action area is

located y o u m a y select Cr i t e r i o n A

. Y o u m u st al so p r o v i de a des c r ip t i o n o f t h e ba s i s f o r t h e c r i t er i o n s e l e c t ed

an d p r o v i de d o c u me n t a t i o n su pp o r t in g t h e c r i t er i o n selected in your submittal

.

 I f the r e ar e li s ted sp e cies a n d

/or c r itic a l h ab it a t in the coun t ies / t o w n sh ips in your action area, y o u s h ou l d

c o n t ac t you r l o c a l F W S or N MFS office t o de t erm in e i f t h e l i s t ed sp e ci es a re kn o w n t o ex i st within the

specific action area of y o u r minor source an d i f any designated c r i t i c a l ha b i t a t a re a s o ver la p the action area of

y o u r minor source

.

o I f you r l o ca l F W S or N M F S office in d ica t es t h a t t h ese s p e ci es an d /o r c r i t ica l hab i t a t c ou l d ex i s t within the

action area of y o u r minor source

, y o u m us t do one of the following to determine if the species and/or

critical habitat may actually be present in or may use your action area :

 Co n d u c t v i su a l in s p e c t i o n s. T hi s me t h o d m a y be pa r t ic u la r l y su i t abl e f o r s i t es t h a t a re s m all er in

s i z e o r l o ca t ed i n n o n

- na t u r a l s e tt in gs s u c h a s hi g hly u r bani z ed a re a s o r in d u s t r ia l pa r k s w h ere

t h ere i s l i t t l e o r n o na t u r a l hab i t a t

.

 Co n d u c t a f o rm a l bi o l o g i ca l su rv e y

. I n so me ca s e s

, pa r t ic u la r l y f o r la rger s i t es, b i o l o g ica l s u rv e y s

m a y b e a n app r o p r ia t e w a y t o a s s e s s w h e t h er s p e ci es a re l o ca t ed within the action area of y o u r

minor source

. Bi o l o g ica l su rv e y s a r e fre q u e n t ly p erf o rmed b y e n v i r o n me n t a l c o n s u l t in g f i rms. A

b i o l o g ica l su rv e y m a y i n s o me ca s e s b e u se f u l t o c o n d u c t in c o n j u nc t i o n w i t h S t e p s 3, 4 or 5 o f

t h e s e in s t r u c t i o n s.

 I f, after performing one or more of the assessments above, you determine that t h e r e ar e n o li s ted sp e cies

or critical habitat in y our a ct i on ar e a

, y o u m a y select C

r i t e r i o n A

. Y o u m u st al so p r o v i de a des c r ip t i o n o f t h e

ba s i s f o r t h e c r i t er i o n s e l e c t ed an d p r o v i de d o c u me n t a t i o n su pp o r t in g t h e c r i t er i o n selected in your submittal

.EPA Form No. 5900

- 342

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Request for Coverage: Hot Mix Asphalt Plants Page 19 of 24

Version 1.0  If, listed species or critical habitat are located in your action area then proceed to step 3.



### 2. 3 Step 3

D e t erm in e i f t h e Co n s t r u c t i o n/Modification or Operation of Your New or Modified Minor Source is L ik e l y t o

A d ver s e l y A f f e c t L i s t ed T h re a t e n ed o r En d an gered S p e ci es o r D e s i g na t ed C r i t ica l H a b i t a t

I f i n S t ep 2 y o u de t erm in e

, ba s ed o n c o mm u nica t i o n w i th yo u r l o ca l F WS or N M F S office

, o r o t h erwise, t ha t l i s t ed

s p e ci es an d /o r c r i t i c a l habi t a t c ou l d ex i s t within the action area of your new or modified minor source

, y o u m u s t

n ext a s se s s w h e t h er the construction/modification or operation of your new or modified minor source is lik e l y t o a dver s e l y

a ffe c t li s t ed t h re a t e n ed o r e n d an gered s p e ci es o r d e s i g na t ed c r i t ica l h a b i t a t.

P o t e n t ia l a dver s e effe c t s fr o m construction/ modification and operation activities incl u de direct and indirect effects and

could include, but are not limited to, the following:

 Ha b i t a t Disturbance

. Surface disturbance activities such as e x ca v a t i o n

, s i t e deve l o p me n t, gr a d in g, and associated

light and noise m a y a dverse l y a ffe c t li s t ed s p e ci es o r t h e i r habi t a t

.

 Operation of the Source. Source operations could result in additional traffic, noise and light that could affect

species or habitat.

 Water

- Related Impacts. Changes in water usage or water discharges may affect listed species or their habitat.

 Air Emission Impacts. Increases in emission of certain pollutants may i n certain cases affect vegetation growth

patterns that can affect listed species or their habitat.

T h e s c o p e o f e ffe c t s t o c o n s i der w il l v a ry w i t h e a c h site and project

. I f yo u a re ha v in g d i ff ic u l t y de t erm inin g w h et h er

y o u r p r o je c t i s lik e l y t o a dver s e l y a ffe c t li s t ed s p e ci es o r c r i t ical habi t a t

, o r o n e o f t h e S e r v ic es ha s al re a dy r ai sed

c o nc er n s t o y o u

, y o u s h o u l d c o n t act t h e app r o p r i a t e o ff ic e o f t h e F W S or N MF S f o r a s s i st anc e.

 I f a d v e rs e e

ff e cts to li s ted th r e a tened or en da n g e r ed sp ecies or their c r itic a l h ab it a t ar

e not l i kel y

, t h e n y o u

m a y s e l e c t Cr

i t e r i o n B

. Y o u m u st p r o v i de t h e f o ll o w in g s p e ci f i c in f o rm a t i o n with your submittal :

1 . The feder all y li s t ed s p e ci es an d /o r d e s i g na t ed hab i t a t that a re l o ca t ed within the action area of your minor

source ;

2 . T h e d i s t anc e b et w een you r s i t e an d t h e li s t ed s p e ci e s o r des i g na t ed c r i t ica l h a b i t a t ( i n m il es ); and

3 . Any other information necessary to show that the construction/modification and operation of your source are

not likely to cause any adverse effects to the listed threatened or endangered species or their critical habitat.

 If adverse effects to listed threatened or endangered species or their critical habitat are likely, you must

follow Step 4 below.EPA Form No. 5900

- 342

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Request for Coverage: Hot Mix Asphalt Plants Page 20 of 24

Version 1.0 

### 2. 4 Step 4

D e t erm in e i f M e a s u r e s C a n B e I m pl eme n t ed t o A v o i d A d ver s e E f f e c t s

I f yo u de t erm in e i n S t ep 3 t ha t a dver s e effe c t s fr o m the construction/modification or operation of your new or

modified minor source are lik e l y to o c c u r

, y o u ca n s t i l l select e li g ibili t y C r i t er i o n B i f you undertake app r o p r ia t e

me a su res t o a v o i d o r e li m ina t e t h e lik e l ih oo d o f a dve r se ef f e c t s p r i o r t o seeking c o v er a g e under the General Permit

.

T h ese me a su r es m a y in v o l ve re la t i ve l y s i m pl e chan ges t o c o n s t r u c t i o n ac t i v i t i es s u c h a s re

- r ou t in g construction t o

b y pa s s a n a rea w h ere s p e ci es a re l o ca t ed, re l o ca t in g source activities

, o r m o d i f y in g t h e “ f oo t p r in t ” o f t h e site

.

 I f y ou ar e ab l e to im p le m ent appr o pr i a te me as u r

es to av oid the likelihood of adv e rs e e f f e ct s

, t h en y o u m a y

s e l e c t C r i t e r i o n B

. T h e me a s u r e s y o u a d o p t t o a v o i d o r e li m ina t e a dver s e e ffe c t s m u st b e i m pl eme n t ed f o r t h e

d u r a t i o n o f t h e c o n s t r u c t i o n/modification and operation of your new or modified minor source an d y o u r

c o v er a ge u n der t h is General Permit

. Yo u m us t al so p r o v i de a d e s c r ip t i o n o f t h e ba s i s f o r t h e c r i t er i o n s e l e c t ed,

an d t h e f o ll o w in g s p e ci f i c in f o rm a t i o n o n y o u r request for coverage f o r m : ( 1 ) the feder all y li s t ed s p e ci es

an d /o r d e s i g na t ed hab i t a t that a re l o ca t ed within the action area of your minor source ; ( 2 ) t h e d i s t anc e b et w een

you r source an d t h e li s t ed s p e ci e s o r des i g na t ed c r i t ica l h a b i t a t ( i n m il es ); and (3) what steps were or will be

taken to avoid the likelihood of adverse effects.

 I f y ou c a n n ot determine sufficient me as u r es to im p l em ent to a v

oid the l i kelih oo d of ad v e rs e e

ff e ct s

, y o u

m u s t f o ll o w t h e p r o c ed u r e s i n S t ep 5

.



### 2. 5 Step 5

Coordinate with the Service(s)

I f i n S t ep 4 y o u cann o t determine sufficient me a su res t o a v o i d t h e lik e lih oo d o f a dver s e e f fe c t s

, y o u m u s t c o n t a c t t h e

applicable Service(s)

. Yo u m a y s t il l b e e li g ibl e f o r c o ver a ge under th e General Permit i f the lik e l y a dver s e ef f e c t s c an b e

a ddre s sed t h r o u gh mee t in g c r i t er i o n C

.

 Cr ite r ion C : Y o u ha ve c o o rd ina t ed w i t h t h e S erv ic e(s) an d ha ve a ddre s s ed t h e effe c t s o f the

construction/modification and operation of your new or modified minor source o n fe d er all y

- li s t ed t h re a t e n ed

o r e n d an gered s p e ci es an d feder all y

- d e s i g na t ed c r i t ica l hab i t a t. The Service(s) must provide w r i t t e n

c o nc u rre nc e t ha t the construction/modification and operation of your new or modified minor source is n o t

lik e ly t o a dverse l y a f fe c t li s t ed s p e ci es o r c r i t ica l hab i t a t

.

o I f yo u ha ve obtained the Service(s) written concurrence as described above

, then y o u m a y s e l e c t Criterion C.

As part of your submittal, y o u m u st p r o v i de a d e s c r ip t i o n o f t h e ba s i s f o r t h e c r i t er i o n s e l e c t ed an d m us t

incl u de c o p i es o f t h e c o rr e s p o n de n c e b e tw een yo u an d t h e applicabl e S erv ic e(s).EPA Form No. 5900

- 342

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Request for Coverage: Hot Mix Asphalt Plants Page 21 of 24

Version 1.0 

## A pp en d i x B

– H i s to r ic P r o p e r ty Sc r e ening P r oce s s

1.0 B a ck gr ound

T h e p u r p os e o f t hi s appendix i s t o a s s i s t y o u i n completing t h e

screening procedure for addressing historic properties that are

either listed on, or eligible for listing on, the National Register for

Historic Places prior to submitting your request for coverage under

a General Air Quality Permit for New or Modified Minor Source Hot

Mix Asphalt Plants in Indian Country

. I n o rder t o b e e l i g ibl e f o r

c o ver a ge u n d e r the General Permit

, y o u must de m o n s t r a t e t h a t

yo u qualify under o n e o f t h e c r i t er i a l i s t ed i n t h i s app e n d ix 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 hi storic properties under the NHPA.

T o a ddre s s an y i s s u e s re la t in g t o hi s t o r ic p r o p er t i es, the EPA ha s

d ev e l o p ed t h e s c ree nin g p r o c ess i n t hi s app e n d i x t o e nabl e source

owners/operators t o: (1) app r o p r ia t e ly c o n s i der t h e p o t e n t i a l

i m pac t s

, i f any

, resulting from the construction, modification, and/or

operation of a new or modified emission source o n hi s t o r ic

p r o p er t i es an d, (2) if applicable, de t erm in e w h e t h er a c t i o n s ca n b e

t ak e n t o m i t i g a t e an y su c h i m pac t s

. A l t h ou gh each decision that a specific minor source meets the requirements for coverage

u n der t hi s General Permit does n o t c o n s t i t u t e a s e pa r a t e F eder a l u n der t akin g, t h e s c ree nin g p r o c ess i n t hi s app e n d i x

p r o v i des a n app r o p r ia t e si t e

- s p e c i f i c me an s o f ad dres s in g hi s t o r i c p r o p e r t y i s s u e s i n c o nn e c t i o n w i t h coverage under the

General Permit

.

If the impacts from your source have already been reviewed under another Federal agency’s approval process (e.g., the

Bureau of Indian Affairs authorizing operation of your source in Indian country) then documentation from that review

may satisfy the requirements of this section. In some cases the review by another agency will have evaluated the

impacts from si te disturbance activities (e.g., site clearing), but not from air emissions. In such cases supplemental

evaluation may be required to complete the analysis.



### 2.0 I n s t r uctions f

or Source Owners/ Op e ra to r s

Y o u a re re q u i red t o f o ll o w t h e s c ree nin g p r o c ess i n t hi s app e n d i x t o de t e r m in e i f the construction, modification or

operation of a new or modified minor source of air pollutants o n y o u r s i t e 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

, an d w h e t h er o r n o t y o u n eed t o c o n t ac t you r State Historic Preservation Officer ( S H PO)

, Tribal Historic

Preservation Officer ( T H P O)

, o r o t h er t r iba l re p r e s e n t a t i ve f o r f u r t h er in f o rm a t i o n

. Yo u m a y n o t su b m i t your

Notification of Coverage under the General Permit u n t i l y o u ha ve c o m pl e t ed t hi s s c ree nin g p r o c e s s and obtained

confirmation of satisfactory completion from the EPA

. T h e f o ll o w in g f ou r s t e p s d e s c r ib e h o w app l ica n t s ca n meet t h e

hi s t o r i c p r o p erty re q u i r e me n t s u n der t hi s p erm i t

. K ey T e rm s

H i sto r ic p r o p e r ty

- pr e h i s t o r i c o r h i s t o r i c d i s t r i c t s

,

s i te s

, b u i l d i n gs

, s t r uctu r e s

, o r ob j ec t s t h a t a r e

i n c l u d e d i n o r e l i g i b l e fo r i n c l u s i o n i n t h e Na t i ona l

R e g i s ter o f H i s t o r i c P l a c e s

, i n c l u d i n g a r t i f a ct s

,

r ec or ds

, a n d r e m a i n s t h a t a r e r e l a ted to an d l o c a ted

w i t h i n s uch prop e r t i e s

S H PO

– T h e S t a te H i s t o r i c P r e s e rv a t i o n O f f i cer fo r

a p a r t i c u l a r s t a te

T H P O o r T r ibal r e p r ese n t a t i v e

– T h e Tr i b a l H i s t o r i c

P r e s e rv a t i o n O f f i cer fo r a p a r t i c u l a r Tr i b e or

, i f t h e r e i s

n o T H P O

, t h e r e pr e s e n t a t i v e d e s i g n a t e d b y s uch T r i b e

fo r NH P A p u rpo s esEPA Form No. 5900

- 342

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Request for Coverage: Hot Mix Asphalt Plants Page 22 of 24

Version 1.0 

### Step 1

Ha ve p r i o r p r o f e s s i o na l c u l t u r a l re s o u r c e s u rv e y s o r o t h er ev al u a t i o n s de t e r m i n ed whether h i s t o r i c

p r o p ert i es ex i st in the area of your proposed source? Or, have p r i o r earth d i s t u r banc es p re cl u ded t h e

ex i s t e nc e o f h i s t o r i c p r op ert i e s in the area of your proposed source?

I f it h a s al re a dy b een de t erm i n ed t h a t n o hi s t o r i c p r o p er t i es ex i st in the area of your proposed source ba s ed

o n a v ailabl e in f o rm a t i o n

, incl u d in g in f o rm a t i o n t h a t m a y b e p r o v i ded b y y o u r applica b l e S H P O

, T H P O

, o r

o t h er t r iba l re p re s e n t a t i ve, t h en yo u m a y submit the appropriate documentation of “no historic properties

affected” with y o ur submittal

, an d n o f u r t h er s c ree nin g s t e p s a re n e c e s s a r y

.

Similarly, i f e a r t h d i s t u r banc es t ha t h a ve o cc u rred p r i o r t o y o u r p r o je c t ha ve e li m ina t ed t h e p os s ibil i ty t ha t hi s t o r i c

p r o p er t i es ex i st o n y o u r s i te or in the area affected by your new or modified minor source

, t h en yo u m a y submit the

appropriate documentation of “no historic properties affected” with y o ur submittal

, an d n o f u r t h er s c ree nin g s t e p s a re

n e c e s s a r y

.

During the 30

- day period following receipt of your screening process documentation by the EPA , the SHPO, THPO, or

other tribal representative may request that the EPA deny coverage under the General Permit based on concerns about

potential adverse impacts to historic properties. The EPA will evaluate any such request and notify you if any additional

information is needed to address adverse impacts to historic properties.



### S t ep 2

I f yo u a re constructing, or modifying a minor source of air pollutants, as defined in 40 CFR § 49.152

, yo u m us t

d e t erm in e i f the construction, modification or operation of the minor source w i l l ha ve a n ef f e c t o n h i s t o r i c

p r o p ert i es.

I f you r an s w er t o t h e q u e s t i o n s i n S t e p 1 i s “n o, ” t h en y o u m us t a s s e s s w h e t h er the ac t i v i t i es re la t ed t o t h e

construction, modification or operation of your new or modified minor source w i l l ha ve a n e ff e c t o n h i s t o r i c p r o p ert i e s.

Activities that could have an adverse effect on historic properties could include, for example:

 Excavations;

 Demolitions of existing buildings;

 Construction of f oundations (e.g., for buildings, tanks or stacks);

 Installations of underground tanks;

 Addition of impervious surfaces; and

 Increases in truck traffic during excavation, demolition, or construction.

No t e : T h i s l i s t i s n o t i n t e n ded t o b e ex ha us t i ve. Ot h er activities t ha t a re n o t o n t h i s l i st m a y in v o l ve e a r t h

- d i s t u r b i n g

a c t i v i t i es an d m u s t al

so b e ex a m i n ed f

o r t h eir p o t e n t i a l t o a

f f e c t h i s t o r i c p r o p ert i e s . For more information, go to the

National Park Service, National Register of Historic Places database found at

http://www.nps.gov/history/nr/research/index.htm

.

T he a s se ss m e n t m a y b e ba s ed on a site map of your source and an analysis of h i s t o r i c a l sou r c e s

, kn o w l edge o f t h e a re a

,

a n a s se s s m e n t o f t h e t y p es o f a c t i v i t i es yo u a re e n g a g i n g in

, c o n s i der a t i o n s o f an y c o n t r o l s an d / o r m ana ge m e n t

p r ac t ic es y o u w i l l a d o p t t o e n su re t ha t y o u r a c t i v i t i es w i l l n o t h a ve a n e ff e c t o n h i s t o r i c p r o p ert i es, an d any o t h er

re l ev an t f ac t o rs.EPA Form No. 5900

- 342

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Request for Coverage: Hot Mix Asphalt Plants Page 23 of 24

Version 1.0 I f y o u de t er m in e ba sed o n t h i s a s s es s m e n t t h a t the activities re la t ed t o t h e construction, modification or operation of

your new or modified minor source w i l l n o t ca u se e ff e c t s to h i s t o r i c p r o p ert i e s

, t h en yo u m a y submit the appropriate

documentation of “no historic properties affected” with y o ur submittal

, an d n o f u r t h er s c ree nin g s t e p s a re n e c e s s a r y

. During the 30

- day period following receipt of your screening process documentation by the EPA , the SHPO, THPO, or

other tribal representative may request that the EPA delay your coverage under the General Permit based on concerns

about potential adverse impacts to historic properties. The EPA will evaluate any such request and notify you if any

additional information is needed to address adverse impacts to historic properties.

I f yo u a re in s t allin g or modifying equipment that ha s t h e p o t e n t i a l t o ha ve a n adverse effe c t o n hi s t o r i c p r o p er t i es, t he n

y o u m u st p r o c eed t o S t ep 3.



### Step 3

I f yo u a re constructing or modifying a minor source an d y o u ha v e n o t s a t i sf i ed t h e c o n d i t i o n s i n S t e p s 1

- 2

, yo u

m us t c o n t ac t a n d c o n su l t w i t h t h e app r o p r i a t e h i s t o r i c p re s erv a t i o n a u t h o r i t i es.

Wh ere y o u a re constructing or modifying a minor source an d y o u cann o t de t erm in e i n S t ep 2 t h a t t his ac t i v i ty w il l n o t

ha ve effe c t s o n hi s t o r ic p r o p er t i e s

, t h en y o u m us t c o n t ac t t h e re l ev a n t S H P O

, T H P O

, o r o t h er t r iba l r e p re s e n t a t i ve t o

re q u est t h e i r v i e w s a s t o t h e lik e lih oo d t h a t hi s t o r i c p r o p er t i es m a y b e adversely affected b y t h e construction,

modification or operation o f your new or modified minor source

.

No t e : A ddre s s es f

o r S H P O s an d T

H POs m a y b e fo u n d o n t h e A dv i s o r y C o un c i l o n H i s t o r i c Preserv a t i o n ’s (ACHP’s) w e b s i t e

( http://www.achp.gov/programs.html )

. I n i n s t a n c es w h ere a t r i b e d o es n o t ha ve a T H PO, y o u s h o u l d c o n t ac t t h e

app r o p r ia t e T r iba l g o ver n m e n t o

ff i c e des i g n a t ed b y t h e t r i b e f o r t h i s p u r

p os e w h en re s p o n d i n g t o t h i s p e r m i t e l i g i b i l i t y

c o n d i t i o n

.

Y o u m u st su b m i t t h e f o ll o w in g m i n i m u m in f o rm a t i o n i n o rder t o p r o p er l y ini t ia t e you r re q u e s t f o r in f o rm a t i o n :

1. Project name (i.e., the name or title most commonly associated with your project);

2. A narrative description of the project;

3. Name, address, phone and fax number, and email address (if available) of the operator;

4. Most recent U.S. Geological Survey map section (7.5 minute quadrangle) showing actual project location and

boundaries clearly indicated; and

5. Sections of site map that show locations where activities might cause an adverse effect on historic properties.

Wi t h ou t s u b m i t t in g t hi s m i ni m u m in f o rm a t i o n

, y o ur request cannot be considered. Yo u w il l n eed t o p r o v i de t h e

S H P O

, T H PO

, o r o t h er t r iba l re p rese n t a t i ve a m ini m u m o f 15 cal e n d a r d a y s a f t er t h ey re c e i ve t h ese m a t er ial s t o

res p o n d t o y o u r re q u est f o r in f o rm a t i o n ab ou t y o u r p r o je c t

. Y o u a re a dv i sed t o get a r e c e ip t fr o m t h e p o st o ff ic e o r

o t h er ca rr i er c o n f i rm in g t h e d a t e o n w h i c h y o u r l e tt er w a s re c e i v ed.

I f yo u d o n o t re c e i ve a r e s p o n s e w i t hin 15 cal e n d a r d a y s a f t er re c e ip t b y t h e S H P O

, T H PO

, o r o t h er t r iba l re p re s e n t a t i ve

o f y o u r re q u e s t

, t h en y o u m a y in d ica t e t h i s in your submittal

, an d n o f u r t h er s c ree nin g s t e p s a re n e c e s s a ry

. O r

, i f t h e

applicabl e S H PO, T H P O

, o r o t h er t r ib a l re p rese n t a t i ve re s p o n ds t o y o u r re qu est w i t h a n i n d ica t i o n t h a t n o hi s t o r i c

p r o p er t i es w i l l be adversely a ffe c t ed b y t h e construction or modification of your minor source

, t h en yo u m a y submit the

appropriate documentation of “ no adverse effects ” with y o ur submittal

, an d n o f u r t h er s c ree nin g s t e p s a re n e c e s s a r y

.EPA Form No. 5900

- 342

EPA ICR No. 1230.27

OMB Control No. 2060

- 0003

Approval expires 4/30/2017

Request for Coverage: Hot Mix Asphalt Plants Page 24 of 24

Version 1.0 If within 15 calendar days of receipt of your request the applicable SHPO, THPO, or other tribal representative

responds with a request for additional information or for further consultation regarding appropriate measures for

treatment or mitigation of effects on historic properties caused by the construction, modification or operation of your

minor source, you must comply w ith this request and proceed to Step 4.

During the 30

- day period following receipt of your screening process documentation by the EPA , the SHPO, THPO, or

other tribal representative may request that the EPA place a hold on authorization based on concerns about potential

adverse impacts to historic properties. The EPA will evaluate any such request and notify you if any additional

information is needed to address adverse impacts to historic properties before continuing review of your requ est for

coverage under the general permit

.



### 2.4 Step 4

Co n s u l t a t i o n w i th you r app l i ca b l e S H PO, T H PO, o r o t h er t r i b a l re p rese n t a t i v e.

I f, f o ll o w in g y o u r d i s c us s i o n s w i t h t h e app r o p r ia t e h i s t o r i c p reserv a t i o n a u t h o r i t i es i n S t ep 3

, t h e applicabl e S H P O

, T H P O

,

o r o t h er t r iba l re p r e se nta t i ve re q u es t s a dd i t i o na l in f o rm a t i o n o r f u r t h er c o n s u l t a t i o n

, y o u m us t res p o n d w i t h s u c h

in f o rm a t i o n o r c o n s u l t to de t erm in e i m pac t s and appropriate measures to mitigate such impacts t o hi s t o r i c p r o p er t i es

t ha t m a y b e cau sed b y t h e construction, modification or operation of your new or modified minor source s i t e. If after

consultation it is determined that there will be no adverse effects to historic properties, t h en yo u m a y submit the

appropriate documentation of “ no adverse e ffects ” with y o ur submittal , and no further screening steps are necessary. I f a s

a re s u l t o f y ou r d i s c us s i o n s w i t h t h e app li cabl e S H P O

, T H P O

, o r t r iba l re p re s e n t a t i ve, y o u e n t er i n t o

, an d c o m ply w i t h

, a

w r i tt en a greeme n t reg a rd in g t re a t me n t a n d /o r m i t i g a t i o n o f i m pac ts o n y o u r s i t e, t h en yo u m a y submit the appropriate

documentation of “ adverse effects ” with y o ur submittal

.

I f, h o w ever, a greeme n t o n a n app r o p r ia t e t re a tme n t o r m i t i g a t i o n pla n c ann o t be re ach ed b e tw een yo u a n d t h e S H P O

,

T H PO

, o r o t h er t r iba l re p re s e n t a t i ve w i t hi n 30 d a y s o f y o ur re s p o n se t o t h e S H PO

, T H P O

, o r o t h er t r iba l

re p rese n t a t i ve’s re q u est f o r a d d i t i o na l in f o rm a t i o n o r f u r t h er c o n s u l t a t i o n

, y o u m a y s u b m i t y o u r screening process

documentation

, b u t y o u m u st in d ica t e t h a t yo u ha ve n o t n eg o t ia t ed me a s u res t o a v o i d o r m i t i g a t e su c h e f fe c t s. Yo u

m u st al so incl u de the following with your submittal :

1. Copies of any written correspondence between you and the SHPO, THPO, or other tribal representative; and

2. A description of any significant remaining disagreements as to mitigation measures between you and the SHPO,

THPO, or other tribal representative.

During the 30

- day period following receipt of your submittal by the EPA , the SHPO, THPO, ACHP or other tribal

representative may request that the EPA place a hold on confirmation based upon concerns regarding potential adverse

effects to historic properties. The EPA, in coordination with the SHPO, THPO, ACHP or other tribal representative, will

evaluate any such request and notify you if any additional measures to address potentia l adverse effects to historic

properties are necessary.