FORM A-1

COMPANY INFORMATION

I. Parent Company / Legal Corporate Owner Information

1. Legal Parent Company / Legal Corporate Name

2. Mailing Address

3. City

4. State

5. Zip Code

6. County

7. Size of Company (approximate number of employees 

including all subsidiaries, branches, and related 

establishments owned):

Page 1 of 1

DRAFT PVC Section 114 Survey Part 1

06/23/2009
FORM P

PROCESS VENT EMISSIONS TESTING DATA

Instructions

1. Copy this worksheet as necessary for pollutants/compounds sampled on different dates.

2. For multiple control devices, users may copy this worksheet within this workbook.

Control Equipment ID:

Indicate whether the inlet to the control device is from the PVC process only ("dedicated") or from the PVC 

process and another process unit (non-PVC) ("combined"):

Parameter

Test Date (mm/dd/yy)

Required Operating Parameters During Test

Total Heat Input (MMBtu/hr)

Fuel 1

Feed Rate

HHV

Fuel 2

Feed Rate

HHV

Fuel 3

Feed Rate

HHV

Flow Rate

Temperature

Moisture

O2

CO2

Number of PVC resin grades being produced during sampling

Number of PVC resin grades being produced (as percentage of all resin grades produced by facility)

Testing Data

Compound

Benzene

Chloroethane

Chloroform

Chloroprene

1,1-Dichloroethane

1,2-Dichloroethane

n-Hexane

Methylene chloride

Toluene

1,1,1-Trichloroethane

1,1,2-Trichloroethane
Vinylidene chloride

Acetophenone

Bis(2-ethylhexyl) phthalate (DEHP)

1,4-Dichlorobenzene

2,4-Dinitrophenol

Hexachlorobutadiene

Hydroquinone

Naphthalene

Phenol

1,2,4-Trichlorobenzene

Acetaldehyde

1,3-Butadiene

Chlorobenzene

Chloromethane

Cumene

Ethylbenzene

Ethylene glycol

Formaldehyde

Methanol

1,1,2,2-Tetrachloroethane

2,2,4-Trimethylpentane

Vinyl acetate

Vinyl bromide

Xylenes (isomers and mixtures)

Vinyl chloride

Methane (CH4)
CAS Number Run #1 Run #2 Run #3 Units

Enter the CAS number for 

each pollutant/compound. 

Do not include dashes.

Select appropriate unit from list.

MMBTU/hr

MMBTU/hr

BTU/scf

MMBTU/hr

BTU/scf

MMBTU/hr

BTU/scf

dscfm

deg F

%

%

%

%

CAS Number

71432 ppmvd @ 3% O2

75003 ppmvd @ 3% O2

67663 ppmvd @ 3% O2

126998 ppmvd @ 3% O2

75343 ppmvd @ 3% O2

107062 ppmvd @ 3% O2

110543 ppmvd @ 3% O2

75092 ppmvd @ 3% O2

108883 ppmvd @ 3% O2

71556 ppmvd @ 3% O2

79005 ppmvd @ 3% O2

Enter numerical value only.

Enter numerical value only.
75354 ppmvd @ 3% O2

98862 ppmvd @ 3% O2

117817 ppmvd @ 3% O2

106467 ppmvd @ 3% O2

51285 ppmvd @ 3% O2

87683 ppmvd @ 3% O2

123319 ppmvd @ 3% O2

91203 ppmvd @ 3% O2

108952 ppmvd @ 3% O2

120821 ppmvd @ 3% O2

75070 ppmvd @ 3% O2

106990 ppmvd @ 3% O2

108907 ppmvd @ 3% O2

74873 ppmvd @ 3% O2

98828 ppmvd @ 3% O2

100414 ppmvd @ 3% O2

107211 ppmvd @ 3% O2

50000 ppmvd @ 3% O2

67561 ppmvd @ 3% O2

79345 ppmvd @ 3% O2

540841 ppmvd @ 3% O2

108054 ppmvd @ 3% O2

593602 ppmvd @ 3% O2

1330207 ppmvd @ 3% O2

75014 ppbvd @ 3% O2

74828 ppmvd @ 3% O2
Run # 1 Detection Run # 2 Detection Run # 3 Detection

Identify the status of measured 

values relative to the detection 

levels

Identify the status of measured 

values relative to the detection 

levels

Identify the status of measured 

values relative to the detection 

levels

Analysis Method Used Note(s)

Where applicable, select the analysis method 

used.

For all pollutants/compounds, provide any other information 

supporting information you think is necessary about this test 

report. 

SW-846 Method 8260B

SW-846 Method 8260B

SW-846 Method 8260B

SW-846 Method 8260B

SW-846 Method 8260B

SW-846 Method 8260B

SW-846 Method 8260B

SW-846 Method 8260B

SW-846 Method 8260B

SW-846 Method 8260B

SW-846 Method 8260B
SW-846 Method 8260B

SW-846 Method 8270D

SW-846 Method 8270D

SW-846 Method 8270D

SW-846 Method 8270D

SW-846 Method 8270D

SW-846 Method 8270D

SW-846 Method 8270D

SW-846 Method 8270D

SW-846 Method 8270D

US EPA Method 18
FORM Q

TOTAL HYDROCARBON 30-DAY MONITORING

Instructions

1. For multiple control devices, users may copy this worksheet within this workbook.

2. Add additional rows as necessary to provide 30 days of monitoring data.

Control Equipment ID:

Date and Time THC Reading CH4 Reading O2 level in exhaust gas

MM/DD/YYYY HH:MM (ppmvd as propane @ 3% O2) (ppmvd @ 3% O2) (% by volume, dry)

Indicate whether the inlet to the control device is from the PVC process only ("dedicated") or from the 

PVC process and another process unit (non-PVC) ("combined"):














Moisture in exhaust 

gas

PVC Type PVC Grade Control Device 

Temperature

(% by volume) (e.g., suspension, 

dispersion/emulsion, bulk, etc.) (e.g., GP, HMW, LMW, etc.) (degF)














Control Device 

Operations Indicator

THC Monitoring 

Operations Indicator 

(note periods of start-up, 

Shutdown, malfunctions, or 

normal operation) 

(note periods of abnormal 

operations)