## United States Environmental Protection Agency

General Permit for New or Modified Minor Sources of Air Pollution in

Indian Country

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

Request for Coverage: Gasoline Dispensing Facilities Page 1 of 16

Version 1.0 

## Request for Coverage u nder the General Permit for New or Modified True Minor

Source Gasoline Dispensing Facilities in Indian Country

Last Modified: November 14 , 2013

Version 1. 0

This Request for Coverage under the General Permit for True Minor Source Gasoline Dispensing Facilities applies to

the construction of new, true minor source gasoline dispensing facilities or the modification of existing, true minor

source gasoline dispensing f acilities in Indian Country that dispense, as a sole source, greater than 4,000,000 gallons

of gasoline in National Ambient Air Quality Standard (NAAQS) ozone attainment areas, or dispense, as a sole source,

greater than 2,100,000 gallons of gasoline annua lly in NAAQS ozone nonattainment areas. A gasoline dispensing

facility is any stationary facility which dispenses gasoline into the fuel tank of a motor vehicle, non road vehicle or

equipment, including a nonroad vehicle or nonroad engine used solely for co mpetition

.

You qualify to submit a Request for Coverage under the General Permit if you meet all of the following

criteria :

You plan to construct a true minor source gasoline dispensing facility that dispenses gasoline for resale or

non

- resale purposes OR you plan to modify an existing, true minor source gasoline dispensing facility that

dispenses gasoline for resale or non

- resale purposes;

Your new or modified true minor source gasoline dispensing facility is located within Indian country;

Your facility h as a potential to emit (PTE) less than the New Source Review (NSR) major source thresholds;

If located in a serious, severe or extreme ozone nonattainment area, after the proposed construction or

modification project, your facility is projected to dispense less than 8,000,000 gallons of fuel per year based

on a 12

- month rolling total;

If located in an attainment area for ozone, after the proposed construction or modification project

, your

facility is projected to dispe nse more than 4,000,000 gallons of fuel over a consecutive 12 month period; and

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

, your

facility is projected to dispense more than 2,100,000 gallons of fuel o ver a consecutive 12 month period;

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 e n d an gered o r t h re a t e n ed 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 f o ll o wed 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))

, 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 the

appropriate state o r 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

.Request for Coverage : Gasoline Dispensing Facilities Page 2 of 16

Version 1.0 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 th e Indian Country NSR rule can be found at

40 CFR 49.153.

Information on the o zone 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.

The reviewing authority retains discretion to deny coverage under a general permit and require a source

- specific permit

even if the above criteria are met.



### Instructions

Step 1: Complete all sections of the Request for Coverage under the General Permit . If you have questions, please

contact the reviewing authority

.

Step 2: Certify that your existing or proposed facility is/will be in compliance with the applicable requirements as stated

in 40 CFR 49.162.



### After you submit the Request for Coverage under the General Permit to the Reviewing Authority :

You may not commence construction/modification until you receive a response from the reviewing authority of the

final decision on your application for coverage under this general permit

.

Your r eviewing authority will act on your coverage under the general permit as expeditiously as possible, and will

notify you if more information is needed in writing within 15 days from receipt of your application

. The

reviewing authority will grant or deny coverage under a general permit no later than 45 days after the date the

application is received, comments are reviewed, and all additional information necessary to make an informed

decision has been provided

.

Yo ur reviewing authority will send you a letter notifying you of the approval or denial of your coverage under

this general permit . Such a letter is a final permit action for purposes 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) 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 OMB control number in any

correspon dence. Do not send the completed form to this address.

## United States Environmental Protection Agency

General Permit for New or Modified Minor Sources of Air Pollution in

Indian Country

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

Request for Coverage: Gasoline Dispensing Facilities Page 3 of 16

Version 1.0 

## Request for Coverage under the General Permit for New or Modified True Minor

Source Gasoline Dispensing Facilities in Indian Country

Last Modified: November 14 , 2013

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 Permit for True Minor Source Gas oline Dispensing Facilities or visit:

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

.

For questions regarding this application please contact your reviewing authority.

For instructions on completing this application please see the document “ Instructions f or Request for Coverage

under the General Permit f or New o r Modified True Minor Source Gasoline Dispensing 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 of Owner :

9. 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:Request for Coverage : Gasoline Dispensing Facilities Page 4 of 16

Version 1.0 

### Section 2: Facility and Technical Information

12. This application is for:

New retail gas oline dispensing facility (please describe the proposed new source ).

______________________________________________________________________________________________ _

___________________________________________________________ ____________________________________

New Non

- retail gas oline dispensing facility (please describe the proposed new s ource)

.

_______________________________________________________________________________________________

___________________________________________________________ ____________________________________

Modification of an existing gasoline dispensing 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 for requesting coverage

under this general permit

.

_______________________________________________________________________________________________

_________ __________________________________________________ ____________________________________

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

facility:

_________________________________________ ______________________________________________________

___________________________________________________________ ________________________________ ____

14

. Is your new or modified facility located in a n ozone nonattainment area? Information on the ozone

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

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

.

Yes No

If yes, specify the classification of the ozone nonattainment area:

Marginal Moderate Serious Severe Extreme

1 5

. Is the potential to emit (PTE) of your new facility

, or the emissions increase from your modified existing facility

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

per year (tpy) ? 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, modified, or existing e mission units when

determining PTE.

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 tpyRequest for Coverage : Gasoline Dispensing Facilities Page 5 of 16

Version 1.0 Pollutant Attainment

Area Nonattainment Area

Nitrogen Oxides (NO

X ) 10 tpy 5 tpy

Carbon Monoxide (CO) 5 tpy 2 tpy

Yes No

16

. If located in an attainment area, is the PTE of your facility 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.

Yes No

If you answered ‘No

, ’ your source does not qualify for the minor NSR program. 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, is the PTE of your facility for the particular nonattainment pollutant

less than the NSR major source threshol ds below for ALL pollutants? Be sure to include all existing, new,

and modified emission units.

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 nonattainment area

If you answered ‘No

, ’ your source does not qualify for the minor NSR program. 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.

18

. Do you agree to comply with all requirements of the General Permit as stated in 40 CFR 49.162?

Yes NoRequest for Coverage : Gasoline Dispensing Facilities Page 6 of 16

Version 1.0 Section 3 : Information on Compliance with Federal Statues Necessary for Requesting Cove rage under the

General Permit

19 . Endangered Species Act

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 e n d an gered o r t h re a t e n ed 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 no, you cannot request coverage under this permit.

Yes No

If 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

20 . Nation al Historic Preservation Act

Have y o u f o ll o wed 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 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)

, an d w h e t h er y o u n eed t o c o n t ac t the appropriate state o r 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 ? If no, you cannot request coverage under this permit.

Yes No

If yes, then provide the appropriate documentation to the EPA to qualify for coverage under this permit

.



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



### Name: _____________________________Name: ____________________________Date:__________

(Signature) (Print or Type)



### Title: _____________________________________Request for Coverage : Gasoline Dispensing Facilities Page 7 of 16

Version 1.0 

## A pp e n d i x A

- E n da n g e r ed S p ec i es A c t 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 c o m pl y in g w i t h t h e re q u i reme n t s of your request for coverage under

the General Permit for True Minor Source Gasoline Dispensing Facilities 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 t hi s p erm i t, y o u must 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 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 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 e n d an gered o r t h re a t e n ed 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: E S A 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 E S A C r i t er i a A ppli es

.



### 1.0 ESA Eli g i b ility Cr ite r ia

Y o u m u st c er t i fy i n y o u r request for coverage under the general permit t ha t yo u 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 i n o rder t o b e e li g ibl e f o r c o ver a ge u n d er t h e general permit

. Y o u m u s t al s o s p e ci fy i n your request for coverage

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 with your request for coverage under the general permit . If you do not meet any of these ESA eligibility

criteria, you will not be eligible for coverage under this permit and you must apply for a site

- specific permit.

No t e : ( 1 ) R eg a r d l e s s o f t h e c r i t er i o n s e l e c t ed, y o ur request for coverage 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 Services 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 request for coverage

.

Cr ite r ion A :

N o f eder all y

- li s t ed t h re a te n ed o r e n d an gered s p e ci es o r t h e i r des i g na t ed c r i t i c a l ha b i t a t ( s ) a re lik e l y t o o c c u r within

the action area. 1

Cr ite r ion B :

F eder 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 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 an d 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

or operation of your new or modified source is 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 an d 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 : ( 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 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

1 Action area means all areas to be affected directly or indirectly by the Federal action and not merely the immediate area

involved in the action [50 CFR 402.02].Request for Coverage : Gasoline Dispensing Facilities Page 8 of 16

Version 1.0 listed species or designated critical habitat (in miles); and (3) any other information necessary (e.g., a map) to show

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

to the list ed 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

. T h e c oo rd ina t i o n m us t ha ve a ddre s sed t h e effe c t s o f

y o u r new or modified true 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

, an d m us t ha ve re s u l t ed 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 true 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 es with your request for coverage under the general permit

.

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 F W S an d /o r t h e N M F 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 to 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 habi t a t

.

Y o u m u st 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 you rse l f an d t h e S erv ic es i n y o u r request for coverage under

the general permit

.

Cr ite r ion E :

Y ou r c o n s t r u c t i o n/modification and operation ac t i v i t i es a re a u t h o r i z ed t h r ou g h t h e i ssu anc e o f an incidental take

p erm i t u n der s e c t i o n 10 o f t h e E S A

, an d t hi s a u t h o r i z a t i o n a ddres s e s t h e effe c t s o f t h e source o n 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 es with your request for coverage under the

general permit

.

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

one of the eligibility criteria (A

- E) in this section to remain eligible for coverage under this permit. Documentation of

these requirements must be kept as part of your permit application and shall be maintained by the pe r mittee for the

duration of time the affected emissions unit(s) is (are) covered under the permit.



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

To qualify for this 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 4 below t o de t erm in e t h e E S A 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.Request for Coverage : Gasoline Dispensing Facilities Page 9 of 16

Version 1.0 2.1 Step 1

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 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. 2 T o m ak e t hi s

de t erm ina t i o n

, y o u s h ou l d f i r st de t erm in e 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 i n you r c ou n t y o r

t o w n s hip or nearby counties or townships to determine if species/habitat in those areas could potentially be affected

by the construction/modification or operation of your new or modified source

. T h e l o ca l o ff ic es o f t h e F W S

, N M F S

, an d

S t a t e o r T r ib a l H er i t a ge C e n t ers o f t en m ain t a i n li s t s o f feder all y li s t ed e n d an gered o r t h re a t e n ed s p e ci es o n t h e i r

i n t er n et 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 /

.

No t e : T o 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 ” )

.

I n m o st ca se s

, s p e ci es an d /o r c r i t ica l hab i t a t li s t s 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 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 your coun t y or t o w n s hi p (or nearby areas in which

species/habitat could potentially be affected by the construction/modification of your new or

modified source)

, y o u s h ou l d c o n t ac t you r l o c a l F W S

, N MFS

, o r S t a t e o r T r iba l H er i t a ge C e n t er 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 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

, N M F S

, o r S t a t e o r T r iba l H er i t a ge C e n t er 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 :

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 an d w h e t h er t h ere a re lik e l y t o b e a dverse effe c t s t o s u c h s p e ci e s

. 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 2, 3, or 4 o f t h e s e in s t r u c t i o n s.

Fo ll o w t h e in s t r u c t i o n s i n S t e p s 2

– 4 b e l o w

, a s ap p licabl e. No t e t h a t m an y b u t n o t al l m e a s u r e s

i m p os ed t o p r o t e c t li s t ed s p e ci es u n der t h ese s t e p s w il l al s o p r o t e c t c r i t ica l ha bi t a t

. T h u s

, to mee t

t h e e li g i bi l i t y re q u i reme n t s o f t hi s permit the me a su r es needed t o p r o t e c t c r i t ic a l hab i t a t may be

2 For definitions of terms that you might encounter when hearing or reading about the endangered species program, go to:

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

.Request for Coverage : Gasoline Dispensing Facilities Page 10 of 16

Version 1.0 se pa r a t e fr o m t h os e needed t o p r o t e c t li s t ed s p e ci e s

.

• I f t h e r e ar e n o li s ted sp e cies in y our coun t y or t o w n s hip (or nearby areas in which species/habitat could

potentially be affected by the construction/modification of your new or modified source) a nd no c r itic a l

h a b it a t ar

e a s in your a ct

i on ar e a

, y o u m a y select cr i t e r i o n A as the ESA criterion for which your project is

eligible in your request for coverage under the general permit

. 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 o n y ou r request for coverage f o rm 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.



### 2.2 Step 2

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 1 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

, N M F S

, o r S t a t e o r T r iba l H er i t a ge C e n t er, 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 in certain cases affect vegetation growth

patterns which can affect listed species or their habita t.

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

, N MF S o r N a t u r a l H er i t a ge C e n t er 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 as the ESA criterion for which your project is eligible in request for coverage under the general

permit

. 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 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 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 air emissions from 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 3 below.Request for Coverage : Gasoline Dispensing Facilities Page 11 of 16

Version 1.0 

### 2.3 Step 3

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 m ak e a p re li m ina ry de t erm ina t i o n i n S t ep 2 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 re c e i ve c o ver a g e u n der e li g ibili t y cr i t er i o n B o f

t h is permit i f app r o p r ia t e me a su res a re u n der t ak en 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

applying for c o v er a g e under the 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 o u a re

u nabl e t o determine w hic h m e a su r e s t o i m pl eme n t t o a v o i d t h e lik e lih oo d o f a dver s e eff e c t s, y o u m u s t c oo rd ina t e with,

o r e n t er in t o c o n su l t a t i o n w i t h

, t h e F W S an d /o r N M F S

, i n w hic h c a se y o u w ou l d n o t b e e li g ibl e f o r c o ver a ge u n der

e li g ibi l i t y c r i t er i o n B

, b u t m a y in s t e a d b e e li g ibl e f o r c o ver a ge u n der e li g ibili t y cr i t er io n C, D

, o r E ( de s c r ib ed i n m o re

de t ai l i n S t ep 4 ).

• 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 cr i t e r i o n B as the criterion for which your project is eligible in your requesting coverage under the general

permit

. 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 a 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 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 w hich 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 4

.



### 2.4 Step 4

D e t erm in e i f t h e Eli g i b il i t y R e q u i reme n t s o f C r i t er i o n C

, D

, o r E C a n B e M et

I f i n S t ep 3 y o u cann o t a s c er t ai n w hi c h me a su res t o i m pl eme n t 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 F W S an d /o r N M F 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 this permit i f a n y 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

, D

, o r E

.

• Cr ite r ion C : Y o u ha ve c o o rd ina t ed w i t h either of t h e S erv ic es 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

, w hic h res u l t ed i n a w r i t t e n c o nc u rre nc e f r o m

t h e re l ev an t S erv ic e ( s ) t ha t the construction/modification or 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

.

I f yo u ha ve m et t h e re q u i reme n t s o f c r i t er i o n C

, then y o u m a y s e l e c t criterion C as the criterion for which your

project is eligible for request for coverage under the general permit

. As part of your request for coverage

,

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 with y ou r request for coverage f o r m 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.Request for Coverage : Gasoline Dispensing Facilities Page 12 of 16

Version 1.0 • Cr ite r ion D : Fo rm a l o r in f o rm a l E S A se c t i o n 7 c o n s u l t a t i o n i s p erf o rmed w i t h t h e F W S an d / o r N M F S an d t ha t

c o n su l t a t i o n a ddre ss e s t h e effe c t s o f the construction/modification or operation of y o u r minor source o n

feder all y

- li s t e d an d t h re a t e n ed s p e ci e s an d des i g na t ed c r i t ica l h a b i t a t

. I n o rder t o b e e li g ibl e f o r c o ver a ge

u n der t hi s p erm i t

, c o n s u l t a t i o n m us t re su l t i n a “n o je o pa rdy and no destruction/adverse modification

o pini o n ” o r a w r i tt en c o nc u rre nc e by t h e S erv ic e ( s ) o n a f in d in g t h a t the construction/modification or

operation of your new or modified minor source 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. ( F o r m o re in f o rm a t i o n o n c o n s u l t a t io n

, see 5 0 C F R Part 40 2 )

. I f y o u re c e i ve a “ je o pa r d y or

destruction/adverse modification o pi n i o n

, ” y o u m a y c o n t in u e t o w o rk w i th t h e F W S an d /o r N M F S an d y o u r

p erm i tt i n g a u t h o r i t y t o m o d i fy y o u r p r o je c t so t ha t i t w il l n o t je o pa rd i z e li s t ed s p e ci es o r result in the

destruction or adverse modification of de s i g na t ed c r i t ica l h a bi t a t

.

No t e t ha t m os t c o n su l t a t io n s a re acc o m pli s h ed in f o rm a lly. Wh en c o n d u c t in g in f o rm a l E S A s e c t i o n 7

c o n s u l t a t i o n a s a n o n

- feder a l re p re s e n t a t i ve, y o u m u st f o ll o w t h e p r o c ed u res fo u n d i n 50 C F R P a rt 402 o f

t h e E S A re g u la t i o n s. Yo u m u s t also n o t i fy F W S an d /o r N MF S o f y o u r in t e n t i o n an d a greeme n t t o c o n d u c t

c o n su l t a t i o n a s a n o n

- feder a l re p re s e n t a t i ve.

Your request for coverage under the general permit is not a federal action that triggers ESA section 7. However,

co n s u l t a t i o n m a y o cc u r i n t h e c o n t e x t o f an o t h er feder a l ac t i o n for the same project ( e

. g

., w h ere E S A s e c t i o n 7

c o n s u l t a t i o n w a s p erf o rmed f o r i s su anc e o f a w e t lan ds d redge an d f il l p erm i t f o r t h e p r o je c t or for some other

federal permit or permission )

. A s n o t ed ab o v e

, o p era t o r s m a y

, i f t he y w i s h

, i n i t i a te c o n s u l t a t i o n w i t h t h e S e r v i c es

a t S t e p 3

.

Wh e t h er E S A se c t i o n 7 c o n su l t a t i o n m us t b e p erf o rmed w i t h t h e F W S

, N MF S, o r b o t h S erv ic es d e p e n d s o n t h e

li s t ed s p e ci es t h a t m a y b e a ffe c t ed b y t h e construction/operational ac t i v i t y

. I n ge n er al

, N MF S ha s j u r i s d ic t i o n

o ver m a r in e, e s t u a r in e, an d ana dr o m o u s fish s p e ci e s

. O p er a t o rs s h o u l d al s o b e a w a re t h a t w h i l e f o rm a l s e c t i o n

7 c o n s u l t a t i o n p r o v i des p r ot e c t i o n fr o m inci de n t a l t akin gs liab i l i t y

, in f o r m a l c o n s u l t a t i o n d o es n o t

.

I f yo u ha ve m et t h e re q u i reme n t s o f c r i t er i o n D

, y o u m a y se l e c t c r i t e r i o n D as the criterion for which your

project is eligible in your requesting of coverage under the general permit

. As part of your request for

coverage , y o u m u s t p r o v i de a de 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

documentation demonstrating such eligibility, including c o rr e s p o n de n c e and related ESA consultation

documentation b e tw een you rse l f , the Federal agency or agencies that requested section 7 consultation an d t h e

S erv ic es.

• Cr ite r ion E : Yo u r c o n s t r uc t i o n a c t i v i t i es a re a u t h o r i z ed t h r ou gh t h e i s su an c e o f an incidental take p erm i t

u n der s e c t i o n 10 o f t h e E S A

, an d t ha t a u t h o r i z a t i o n a ddre s s e s t h e effe c t s o f the construction/modification

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

- li s t ed s p e ci es an d de s i g na t ed c r i t ica l h abi t a t

.

Y o u m u s t f o ll o w F W S an d /o r N MF S p r o c e d u res w h en ap p l y in g f o r a n E S A S e c t i o n 10 p erm i t ( 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

.

I f yo u ha ve m et t h e re q u i reme n t s o f c r i t er i o n E

, y o u m a y s e l e c t c r i t e r i o n E as the criterion for which your

project is eligible in your requesting of coverage under the general permit

. As part of your request for

coverage , y o u m u s t p r o v i de a de 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

applicable documentation demonstrating such eligibility including c o rr e s p o n de n c e b e tw een you rse l f an d t h e

S erv ic es.Request for Coverage : Gasoline Dispensing Facilities Page 13 of 16

Version 1.0 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 es 

## 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

S e c t i o n 106 o f t h e N H P A r e q u i res F ede r a l a ge nci es t o t ake in t o

acc ou n t t h e effe c t s o f F e d er a l “ u n der t akin gs

, ” su c h a s t h e General

Permit for True Minor Source Gasoline Dispensing Facilities in

Indian Country

, o n hi s t o r ic p r o p er t i es t h a t a re e i t h er li s t ed o n

, o r

e li g ibl e f o r li s t in g o n

, t h e N a t i o na l R eg i s t er o f Hi s t o r ic P lac es.

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 i n c o nn e c t i o n

w i t h t h e i s s u anc e o f t hi s p erm i t

, 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 to

allow coverage o f in d i v i d u a l minor sources u n der t hi s p erm i t 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 the EPA ’s i s s u anc e o f t h e p erm i t

.



### 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 you r request for

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

. 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

.



### 2.1 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 in d i c a t e t hi s o n y o u r request for coverage under the general

permit

, 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

, y o u m a y in d ica t e t h i s o n

y o u r request for coverage

, 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 ss a r y

.Request for Coverage : Gasoline Dispensing Facilities Page 14 of 16

Version 1.0 After submitting your request for coverage under the general permit , and during the 30

- day period after submitting your

request for coverage under the general permit , the SHPO, THPO, or other tribal representative may request that the EPA

deny coverage under this 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 b efore continuing review of your request for coverage under the general permit

.



### 2.2 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.

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

, y o u m a y i n d i c a t e t h i s o n y o u r request for

coverage under the general permit

, an d d o c u m e n t t h e ba s i s f o r you r de t erm i n a t i o n i n your request for coverage 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

.

After submitting your request for coverage , and during the 30 days after the receipt of your request , the SHPO, THPO, or

other tribal representative may request that the EPA delay your coverage under the permit based on concerns about

potential adverse impacts to historic prope rties. 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 request for

coverage under the general permit

.

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.Request for Coverage : Gasoline Dispensing Facilities Page 15 of 16

Version 1.0 

### 2.3 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 o n y o u r request for coverage under the general permit

, 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 y o u m a y in d ica t e t hi s o n y o u r request for coverage

, and include a copy of the response and n o f u r t h er

s c ree nin g s t e p s a re n e c e ss a r y

. A f t er s u b m i tt in g you r request for coverage

, an d d u r in g t h e 30

- d a ys following the

receipt of your request for coverage

, 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 m a y re qu est t h a t the EPA place a

hold on a u t h o r i z a t i o n ba sed o n c o nc er n s ab o u t p o t e n t i a l a dver s e i m pac t s t o hi s t o r i c p r o p er t i es. The E P A w il l ev al u a t e

an y s u c h re q u e s t an d n o t i f y y o u i f an y a dd i t i o na l information is needed t o a ddress a d v erse i m pac t s t o h i s t o r i c p r o p er t i es

before continuing review of your request for coverage under the general permit

.

I f w i t hi n 15 cal e n d a r d a y s o f re c e ip t o f y o u r re q u e s t t h e ap p lica b l e S H P O

, T H P O

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

re s p o n ds w i t h a re q u est f o r a dd i t i o na l i n f o rm a t i o n o r f o r f u r t h er c o n s u l t a t i o n reg a rd in g app r o p r ia t e m e a su r e s f o r

t re a t me n t o r m i t i g a t i o n o f effe c t s o n h i s t o r i c p r o p er t i es ca u sed b y t h e construction, modification or operation of your

minor source

, y o u m us t c o m pl y w i th t h i s re q u e s t an d p r o c eed t o S t ep 4

.Request for Coverage : Gasoline Dispensing Facilities Page 16 of 16

Version 1.0 

### 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 5, 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. 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 y o u m a y in d ica t e t h i s o n y o u r

request for coverage and include a copy of the written agreement, 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 es s a r y

.

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 request for coverage

, 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

with your request for coverage under the general permit t h e f o ll o w in g d o c u me n t a t i o n :

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 bet ween you and the SHPO,

THPO, or other tribal representative.

After submitting your request for coverage under the general permit , and during the 30

- day period after the receipt of

your request for coverage under the general permit , the SHPO, THPO, ACHP or other tribal representative may request

that the EPA place a hold on authorization 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 potential adverse effects to historic properties are

necessary.