Form Approved 03/28/2011

OMB Control No. 2060-0657

Approval Expires 03/31/2016

Field Name

Field Optional or Required 

for ICR Test Request Note:

Facility Name Required Plant Name as reported in the Component 1 Reporting Tool.

Address Optional

City Optional

State/Zip Optional

Address Optional

City Optional

State/Zip Optional

Contact Optional

Phone Optional

Fax Optional

Email Optional

AFT Number Optional

Industry NAICS Optional

FRS Optional

Latitude Optional

Longitude Optional

Testing Company (TC) Required

TC Address Required

TC City Required

TC State/Zip Required

TC Contact Required

TC Phone Required

Air Permit Number Required

The code is the Facility ID provided in your the Section 114 letter and should be the same as the Facility ID 

you entered for this facility in the Component 1 Reporting Tool.

Source ID-Required Enter the unit ID that you provided for this unit in Component 1 and/or Component 2 of the ICR. 

Name-Optional The name is optional. 

The remainder of the Permit/SCC form Optional The remainder of this form, including the SCC section is optional.

Question 1, 2, and 3 Optional

Question 4a Required Required

If required for your test, you should report the average heat input during the test run (mmBtu/hr); average fuel 

composition and feed rate during each test run; and average steam output (1000 lb steam/hour) during each 

test run. If a control device is installed you must also report control device operating or monitoring parameters 

during each test run (including, as appropriate to the control device, flue gas flow rate, pressure drop, scrubber 

liquor pH, scrubber liquor flow rate, sorbent type and sorbent injection rate), and process parameters 

(including, flue gas oxygen content (%), flue gas carbon dioxide content (%), flue gas moisture content (%), 

flue gas sampling point temperature (Deg F) and pressure (atm), standard temperature (Deg F) and pressure 

(atm), unit gross electrical output (MWe), unit net electric generation (MWh)).

Question 4b Required Required

Question 5a Required Required Listed below in Form: Attachments Source/Process Flow Diagram

Question 5b Required Required

Required data entry fields for data reported in order of process flow. Add description and provide detailed 

description in section 5a. Each control device should have a target value, a unit of measure (UOM), and 

description of what the target value and the UOM represent. These values can be, for example, the guaranteed 

emission limits or performance guarantee provided by control device vendors. Examples would be NOx 

removal efficiency (in percent) for post combustion NOx controls, PM removal efficiency (in percent) for PM 

controls, or SO2 removal efficiency in percent for post combustion SO2 controls. For example, for an ESP, a 

user might enter: in UOM (Percent), in Target (99), and in Comments (PM removal Efficiency).

Question 6 Required Location of test should be downstream from the last control device.

7a Required Each test should be at least comprised of three runs.

7b Required

The units of measure for each method should match the units provided in the instructions included in 

Component 4.

Questions 8-11 Required

Questions 12-16 Required

Questions 17-19 Optional

All Questions Required

Setup / Test Plan Module

List of Required Data Entry Fields for Data Reported in the ERT

Form: Signatures

Permitted State Source ID/Name 

Form: Schedule

Note: Facility does not have to get test plan approved by the Agency, but ERT requires the test plan to be entered into the program before test results can be entered into the system.

Form: Facility/Tester

Form: Permit/SCC 

Form: Regulations

Form: Process/APCD

Form: Locations/Methods

Form: Methods Cont.

Form: Audit/Calibrations
All Questions Required

Source/Process Flow Diagram

Alternate Method Request and Approval (Item 8) 

(optional)

EPA Method 1Location Supporting 

Documentation (Item 9) (optional)

Cyclonic Flow Absence Supporting 

Documentation (Item 10)

Pre-Test Meter Boxes/DGMs Calibrations

Post-Test Meter Boxes/DGMs Calibrations

Nozzles Calibrations

Pitots Calibrations

Thermocouples Calibrations

Sampling Locations Dimensions and Point 

Locations

Run Field Data Sheets

Moisture Recovery

Lab Data including calibrations and detection 

level determinations 

Chain-of-Custody

Observer Comments

APCD Diagram

All Questions Required

All Questions for Report Signatures Form Required

Form: Attachments

Test Data Module

Required (as a part of the 

test report)

Rather than attaching the these items to the ERT, they should be included in the test report submitted to the 

Refinery ICR website or to the ICR email address.

Test Data Review Module

Test Report Module