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

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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

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 facilities 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 annually in NAAQS ozone nonattainment areas. A gasoline dispensing 

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

equipment, including a nonroad vehicle or nonroad engine used solely for competition.

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 has 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 dispense 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 over a consecutive 12 month period;

You demonstrate that you meet one of the criteria listed in Appendix A with respect to the protection of any

and all species that are federally-listed as endangered or threatened under the Endangered Species Act (ESA) 

or of habitat that is federally-designated as “critical habitat” under the ESA; and

You have followed the screening process in Appendix B to determine if the construction, modification or operation 

of your new or modified minor source of air pollutants has the potential to cause effectsto historic properties 

(pursuant to the National Historic Preservation Act (NHPA)), and whether or not you need to contact the 

appropriate state or tribal representative for further information.
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More Information

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

“Instructions” document. Additional information on the applicability of the Indian Country 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.

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 reviewing 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. 

Your 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 send comments on the U.S. Environmental Protection Agency’s (EPA’s) need for the

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 

correspondence. 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

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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

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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 Gasoline 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 for Request for Coverage 

under the General Permit for New or 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. Authorized contact regarding this permit application:

Name:

Title:

Phone: 

Email:

FAX:
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Section 2: Facility and Technical Information

12. This application is for: 

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

_______________________________________________________________________________________________

_______________________________________________________________________________________________

New Non-retail gasoline dispensing facility (please describe the proposed new source).

_______________________________________________________________________________________________

_______________________________________________________________________________________________

Modification of an existing gasoline dispensing facility. Please describe the modification below. The 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 an 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

15. 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 pollutants, 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 emission 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 

(PM10) 5 tpy 1 tpy

Particulate Matter 

(PM2.5) 3 tpy 0.6 tpy

Sulfur Dioxide (SO2) 10 tpy 5 tpy
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Pollutant Attainment 

Area

Nonattainment Area

Nitrogen Oxides (NOX) 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, PM10, PM2.5, VOC, NOX, 

CO, and SO2? 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 thresholds 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 NOX

Moderate 100 tpy of VOC or NOX

Serious 50 tpy of VOC or NOX

Severe 25 tpy of VOC or NOX

Extreme 10 tpy of VOC or NOX

PM10 Moderate 100 tpy

Serious 70 tpy

CO Moderate 100 tpy

Serious 50 tpy

SO2, NO2, PM2.5 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 No
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Section 3: Information on Compliance with Federal Statues Necessary for Requesting Coverage under the

General Permit

19. Endangered Species Act

Have you demonstrated that you meet one of the criteria listed in Appendix A with respect to the protection of

any and all species that are federally-listed as endangered or threatened under the ESA or of habitat that is

federally-designated as “critical habitat” under the ESA? 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 criterion in Appendix A you are satisfying this requirement:

A B C D E

20. National Historic Preservation Act

Have you followed the screening process in Appendix B to determine if the construction, modification or 

operation of your new or modified true minor source of air pollutants has the potential to cause effectsto historic

properties (pursuant to the NHPA), and whether you need to contact the appropriate state or tribal

representative for further information? 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: _____________________________________
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Appendix A - Endangered Species Act Requirements

The purpose of this appendix is to assist you in complying with the requirements of your request for coverage under 

the General Permit for True Minor Source Gasoline Dispensing Facilities in Indian Country. In order to be eligible for

coverage under this permit, you must demonstrate that you meet one of the criteria listed in this appendix with

respect to the protection of any and all species that are federally-listed as endangered or threatened under the ESA

or of habitat that is federally-designated as “critical habitat” under the ESA. 

This appendix provides you information on the following:

• Section 1.0: ESA Eligibility Criteria and

• Section 2.0: Guidance for Determining Which ESA Criteria Applies.

1.0 ESA Eligibility Criteria

You must certify in your request for coverage under the general permit that you meet one of the eligibility criteria listed

below in order to be eligible for coverage under the general permit. You must also specify in your request for coverage

the basis for your selection of the applicable eligibility criterion 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. 

Note: (1) Regardless of the criterion selected, your request for coverage must provide sufficient documentation to support your

determination that you satisfy the requirements of the particular criterion you have selected. (2) While coordination between you

and the U.S. Fish and Wildlife Service (FWS) and/or the National Marine Fisheries Service (NMFS; together, the “Services”) is not 

necessarily required in all cases, the EPA encourages you to coordinate with the Services and to do so early in the planning process

prior to submitting your request for coverage.

Criterion A:

No federally-listed threatened or endangered species or their designated critical habitat(s) are likely to occur within 

the action area.1

Criterion B:

Federally-listed threatened or endangered species or their designated critical habitat(s) are likely to occur within the 

action area of your source and the construction and operation of your new minor source or construction and operation of 

the modification to your existing minor source is not likely to adversely affect listed threatened or endangered species

or critical habitat. This determination may include consideration of any air pollution controls or other changes to the 

construction and/or operation of your new or modified source that you will adopt to ensure that construction, modification 

or operation of your new or modified source is not likely to adversely affect listed species and critical habitat. To make

this certification, you must include the following in your request for coverage: (1) identify any federally listed species

and/or designated habitat located within the action area of your source; (2) the distance between your site and the

 

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].
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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 listed threatened or endangered species or their critical habitat. 

Criterion C:

Coordination between you and the Services has been concluded. The coordination must have addressed the effects of 

your new or modified true minor source’s construction/modification and operation on federally-listed threatened or

endangered species and federally-designated critical habitat, and must have resulted in a written concurrence from the

relevant Service(s) that your new or modified true minor source’s construction/modification and operation are not

likely to adversely affect listed species or critical habitat. You must include copies of the correspondence between 

yourself and the Services with your request for coverage under the general permit.

Criterion D:

Consultation between another Federal Agency and the FWS and/or the NMFS undersection 7 of the ESA has been

concluded. The consultationmust have addressed the effects of your minor source’s construction/modification and 

operation on federally-listed threatened or endangered species and federally-designated critical habitat. The result of

this consultation must be either:

1. A biological opinion that concludesthat the action in question (taking into account the effects of your

source’s construction/modification and operation) is not likely to jeopardize the continued existence of

listed species, or to result in the destruction or adverse modification of critical habitat; or

2. Written concurrence from the applicable Service(s) with a finding that the source’s 

construction/modification and operation are not likely to adversely affect federally-listed species or

federally-designated habitat.

You must include copies of the correspondence between yourself and the Servicesin your request for coverage under 

the general permit.

Criterion E:

Your construction/modification and operation activities are authorized through the issuance of an incidental take 

permit under section 10 of the ESA, and this authorization addressesthe effects of the source on federally-listed species

and federally-designated critical habitat. You must include copies of the incidental take permit and associated 

documentation and correspondence between yourself and the Services 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 permittee for the 

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

2.0 Determining Which Criterion Applies

To qualify for this permit, you need to meet one of the five criteria listed above. You must follow the proceduresin

Steps 1 through 4 below to determine the ESA criterion, if any, under which your project is eligible for permit

coverage.
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2.1 Step 1

Determine if Listed Threatened or Endangered Species or their Designated Critical Habitat(s) are Likely to Occur within 

the Action Area of your Minor Source.

You must determine,to the best of your knowledge, whetherspeciesfederally listed as either threatened or

endangered, or their critical habitat(s), are located within the action area of your minor source.2To make this

determination, you should first determine if listed species and/or critical habitat are expected to exist in your county or

township 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. The local offices of the FWS, NMFS, and

State or Tribal Heritage Centers often maintain lists of federally listed endangered or threatened species on their

internet sites. For FWS terrestrial and aquatic speciesinformation, you can use the FWS on-line mapping tool, the 

Information, Planning, and Consultation System, located at http://www.fws.gov/ipac/.

Note: To determine the field office that correspondsto your project site, visit 

http://www.fws.gov/endangered/regions/index.html and http://www.nmfs.noaa.gov/ (under the left tab for “Regions”).

In most cases,species and/or critical habitat lists allow you to determine if any such species or habitat existsin

your county or township. You can also find critical habitat designations and associated requirements at 50 CFR

Parts 17 and 226 (see http://www.access.gpo.gov). You may also use the FWS Critical Habitat Portal (see 

http://criticalhabitat.fws.gov/crithab/).

• If there are listed species and/or critical habitat in your county or township (or nearby areas in which 

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

modified source), you should contact your local FWS, NMFS, or State or Tribal Heritage Center to determine

if the listed species are known to exist within the action area of your minor source and if any designated 

critical habitat areas overlap the action area of your minor source.

o If your local FWS, NMFS, or State or Tribal Heritage Center indicatesthat these species and/or critical

habitat could exist within the action area of your minor source, you must do one of the following:

Conduct visual inspections. This method may be particularly suitable for sites that are smaller in 

size or located in non-naturalsettings such as highly urbanized areas or industrial parks where

there is little or no natural habitat.

Conduct a formal biologicalsurvey. In some cases, particularly for larger sites, biologicalsurveys

may be an appropriate way to assess whetherspecies are located within the action area of your

minor source and whether there are likely to be adverse effectsto such species. Biologicalsurveys

are frequently performed by environmental consulting firms. A biological survey may in some

cases be useful to conduct in conjunction with Steps 2, 3, or 4 of these instructions.

Follow the instructionsin Steps 2 – 4 below, as applicable.Note that many but not all measures

imposed to protect listed species under these steps will also protect critical habitat. Thus, to meet

the eligibility requirements of this permit the measures needed to protect critical habitat 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/actionarea.htm.
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separate from those needed to protect listed species.

• If there are no listed speciesin your county or township (or nearby areas in which species/habitat could 

potentially be affected by the construction/modification of your new or modified source) and no critical

habitat areas in your action area, you may select criterion A as the ESA criterion for which your project is 

eligible in your request for coverage under the general permit. You must also provide a description of the

basis for the criterion selected on your request for coverage form and provide documentation supporting the

criterion selected.

2.2 Step 2

Determine if the Construction/Modification or Operation of Your New or Modified Minor Source is Likely to

Adversely Affect Listed Threatened or Endangered Species or Designated Critical Habitat

If in Step 1 you determine, based on communication with your local FWS, NMFS, or State or Tribal Heritage Center, or

otherwise,that listed species and/or critical habitat could exist within the action area of your new or modified minor 

source, you must next assess whether the construction/modification or operation of your new or modified minor source is

likely to adversely affect listed threatened or endangered species or designated critical habitat.

Potential adverse effects from construction/ modification and operation activitiesinclude direct and indirect effects and 

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

• Habitat Disturbance. Surface disturbance activities such as excavation,site development, grading, and associated 

light and noise may adversely affect listed species or their habitat. 

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 habitat. 

The scope of effectsto consider will vary with each site and project. If you are having difficulty determining whether

your project is likely to adversely affect listed species or critical habitat, or one of the Services has already raised

concernsto you, you should contact the appropriate office of the FWS, NMFS or Natural Heritage Center for

assistance.

• If adverse effectsto listed threatened or endangered species or their critical habitat are not likely, then you

may select criterion B as the ESA criterion for which your project is eligible in request for coverage under the general 

permit. You must provide the following specific information with your request for coverage form:

1 . The federally listed species and/or designated habitat are located within the action area of your minor 

source;

2 . The distance between your site and the listed species or designated critical habitat (in miles); 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.
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2.3 Step 3

Determine if Measures Can Be Implemented to Avoid Adverse Effects

If you make a preliminary determination in Step 2 that adverse effectsfrom the construction/modification or operation 

of your new or modified minor source are likely to occur, you can still receive coverage under eligibility criterion B of 

this permit if appropriate measures are undertaken to avoid or eliminate the likelihood of adverse effects prior to

applying for coverage under the permit.

These measures may involve relatively simple changesto construction activitiessuch as re-routing construction to

bypass an area where species are located, relocating source activities, or modifying the “footprint” of the site. If you are

unable to determine which measuresto implement to avoid the likelihood of adverse effects, you must coordinate with, 

or enter into consultation with, the FWS and/or NMFS, in which case you would not be eligible for coverage under

eligibility criterion B, but may instead be eligible for coverage under eligibility criterion C, D, or E (described in more

detail in Step 4).

• If you are able to implement appropriate measuresto avoid the likelihood of adverse effects, then you may

select criterion B as the criterion for which your project is eligible in your requesting coverage under the general 

permit. The measures you adopt to avoid or eliminate adverse affects must be implemented for the duration of

the construction/modification and operation of your new or modified minor source and your coverage under

this permit. You must also provide a description of the basis for the criterion selected, and the following specific

information on your request for coverage form: ( 1) the federally listed species and/or designated habitat that 

are located within the action area of your minor source; ( 2) the distance between your source and the listed

species or designated critical habitat (in miles); and (3) what steps were or will be taken to avoid the likelihood 

of adverse effects

• If you cannot determine which measuresto implement to avoid the likelihood of adverse effects, you must

follow the proceduresin Step 4.

2.4 Step 4

Determine if the Eligibility Requirements of Criterion C, D, or E Can Be Met

If in Step 3 you cannot ascertain which measuresto implement to avoid the likelihood of adverse effects, you must

contact the FWS and/or NMFS. You may still be eligible for coverage under this permit if any likely adverse effects can be

addressed through meeting criterion C, D, or E.

• Criterion C: You have coordinated with either of the Services and have addressed the effects of the 

construction/modification and operation of your new or modified minor source on federally-listed threatened

or endangered species and federally-designated critical habitat, which resulted in a written concurrence from

the relevant Service(s) that the construction/modification or operation of your new or modified minor source 

is not likely to adversely affect listed species or critical habitat.

If you have met the requirements of criterion C, then you may select 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, 

you must provide a description of the basis for the criterion selected with your request for coverage form and

must include copies of the correspondence between you and the applicable Service.
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• Criterion D: Formal or informal ESA section 7 consultation is performed with the FWS and/or NMFS and that

consultation addressesthe effects of the construction/modification or operation of your minor source on

federally-listed and threatened species and designated critical habitat. In order to be eligible for coverage

under this permit, consultation must result in a “no jeopardy and no destruction/adverse modification

opinion” or a written concurrence by the Service(s) on a finding that the construction/modification or 

operation of your new or modified minor source are not likely to adversely affect listed species or critical

habitat. (For more information on consultation,see 50 CFR Part 402). If you receive a “jeopardy or 

destruction/adverse modification opinion,” you may continue to work with the FWS and/or NMFS and your

permitting authority to modify your project so that it will not jeopardize listed species or result in the 

destruction or adverse modification of designated critical habitat.

Note that most consultations are accomplished informally. When conducting informal ESA section 7

consultation as a non-federal representative, you must follow the proceduresfound in 50 CFR Part 402 of 

the ESA regulations. You must also notify FWS and/or NMFS of your intention and agreement to conduct

consultation as a non-federal representative.

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

consultationmay occur in the context of another federal action for the same project (e.g., where ESA section 7

consultation was performed for issuance of a wetlands dredge and fill permit for the project or for some other 

federal permit or permission). As noted above, operators may, if they wish, initiate consultation with the Services

at Step 3.

Whether ESA section 7 consultation must be performed with the FWS, NMFS, or both Services depends on the

listed speciesthat may be affected by the construction/operational activity. In general, NMFS has jurisdiction

over marine, estuarine, and anadromousfish species. Operatorsshould also be aware that while formal section

7 consultation provides protection from incidental takings liability, informal consultation does not.

If you have met the requirements of criterion D, you may select criterion 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, you must provide a description of the basis for the criterion selected and must include copies of the

documentation demonstrating such eligibility, including correspondence and related ESA consultation 

documentation between yourself, the Federal agency or agencies that requested section 7 consultation and the

Services.

• Criterion E: Your construction activities are authorized through the issuance of an incidental take permit

under section 10 of the ESA, and that authorization addressesthe effects of the construction/modification 

and/or operation of your new or modified source on federally-listed species and designated critical habitat.

You must follow FWS and/or NMFS procedures when applying for an ESA Section 10 permit (see 50 CFR

§17.22(b)(1) for FWS and §222.22 for NMFS). Application instructionsfor section 10 permits for FWS and 

NMFS can be obtained by accessing the FWS and NMFS websites (http://www.fws.gov and

http://www.nmfs.noaa.gov) or by contacting the appropriate FWS and NMFS regional office.

If you have met the requirements of criterion E, you may select criterion 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, you must provide a description of the basis for the criterion selected and must include copies of the

applicable documentation demonstrating such eligibility including correspondence between yourself and the

Services.
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Key Terms

Historic property- prehistoric or historic districts, sites, 

buildings, structures, or objects that are included in or 

eligible for inclusion in the National Register of Historic

Places, including artifacts, records, and remains that are

related to and located within such properties

SHPO – The State Historic Preservation Officer for a 

particular state

THPO or Tribal representative – The Tribal Historic 

Preservation Officer for a particular Tribe or, if there is no 

THPO, the representative designated by such Tribe for 

NHPA purposes

Appendix B – Historic Property Screening Process

1.0 Background

Section 106 of the NHPA requires Federal agenciesto take into

account the effects of Federal “undertakings,” such as the General 

Permit for True Minor Source Gasoline Dispensing Facilities in 

Indian Country, on historic propertiesthat are either listed on, or

eligible for listing on, the National Register of Historic Places.

To address any issues relating to historic propertiesin connection

with the issuance of this permit, the EPA has developed the

screening process in this appendix to enable source 

owners/operatorsto: (1) appropriately consider the potential

impacts, if any, resulting from the construction, modification, 

and/or operation of a new or modified emission source on historic 

properties and, (2) if applicable, determine whether actions can be

taken to mitigate any such impacts. Although each decision to 

allow coverage of individual minor sources under this permit does 

not constitute a separate Federal undertaking, the screening

processin this appendix provides an appropriate site-specific means of addressing historic property issues in connection

with the EPA’s issuance of the permit.

2.0 Instructions for Source Owners/Operators

You are required to follow the screening process in this appendix to determine if the construction, modification or 

operation of a new or modified minor source of air pollutants on your site has the potential to cause effectsto historic

properties, and whether or not you need to contact your State Historic Preservation Officer (SHPO), Tribal Historic 

Preservation Officer (THPO), or other tribal representative for further information. You may not submit your request for

coverage under the general permit until you have completed this screening process. The following four steps describe

how applicants can meet the historic property requirements under this permit.

2.1 Step 1

Have prior professional cultural resource surveys or other evaluations determined whether historic

properties exist in the area of your proposed source? Or, have prior earth disturbances precluded the 

existence of historic properties in the area of your proposed source?

If it has already been determined that no historic properties exist in the area of your proposed source based

on available information, including information that may be provided by your applicable SHPO, THPO, or

other tribal representative,then you may indicate this on your request for coverage under the general 

permit, and no furtherscreening steps are necessary.

Similarly, if earth disturbancesthat have occurred prior to your project have eliminated the possibility that historic

properties exist on your site or in the area affected by your new or modified minor source, you may indicate this on

your request for coverage, and no furtherscreening steps are necessary.
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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 before continuing review of your request for coverage under the general permit.

2.2 Step 2

If you are constructing, or modifying a minor source of air pollutants, as defined in 40 CFR § 49.152, you must

determine if the construction, modification or operation of the minor source will have an effect on historic 

properties.

If your answer to the questionsin Step 1 is “no,” then you must assess whether the activitiesrelated to the

construction, modification or operation of your new or modified minor source will have an effect on historic properties.

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

Excavations;

Demolitions of existing buildings;

Construction of foundations (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.

Note: This list is not intended to be exhaustive. Other activitiesthat are not on this list may involve earth-disturbing

activities and must also be examined for their potential to affect historic properties. 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. 

The assessment may be based on a site map of your source and an analysis of historicalsources, knowledge of the area, 

an assessment of the types of activities you are engaging in, considerations of any controls and/or management

practices you will adopt to ensure that your activities will not have an effect on historic properties, and any other

relevant factors.

If you determine based on this assessmentthat the activities related to the construction, modification or operation of 

your new or modified minor source will not cause effectsto historic properties, you may indicate this on your request for

coverage under the general permit, and document the basis for your determination in your request for coverage and

no furtherscreening steps are necessary.

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 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 request for

coverage under the general permit.

If you are installing or modifying equipment that has the potential to have an adverse effect on historic properties, then

you must proceed to Step 3.
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2.3 Step 3

If you are constructing or modifying a minor source and you have not satisfied the conditionsin Steps 1-2, you

must contact and consult with the appropriate historic preservation authorities.

Where you are constructing or modifying a minor source and you cannot determine in Step 2 that this activity will not

have effects on historic properties,then you must contact the relevant SHPO, THPO, or other tribal representative to 

request their views as to the likelihood that historic properties may be adversely affected by the construction, 

modification or operation of your new or modified minor source.

Note: Addressesfor SHPOs and THPOs may be found on the Advisory Council on Historic Preservation’s(ACHP’s) website

( http://www.achp.gov/programs.html). In instances where a tribe does not have a THPO, you should contact the

appropriate Tribal government office designated by the tribe for this purpose when responding to this permit eligibility 

condition.

You must submit the following minimum information in order to properly initiate your request for information:

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.

Without submitting this minimum information, your request cannot be considered. You will need to provide the

SHPO, THPO, or other tribal representative a minimum of 15 calendar days after they receive these materialsto

respond to your request for information about your project. You are advised to get a receipt from the post office or 

other carrier confirming the date on which your letter was received.

If you do not receive a response within 15 calendar days after receipt by the SHPO, THPO, or other tribal representative

of your request, then you may indicate this on your request for coverage under the general permit, and no further

screening steps are necessary. Or, if the applicable SHPO, THPO, or other tribal representative respondsto your request

with an indication that no historic properties will be adversely affected by the construction or modification of your 

minor source, then you may indicate this on your request for coverage, and include a copy of the response and no further

screening steps are necessary. Aftersubmitting your request for coverage, and during the 30-days following the 

receipt of your request for coverage, the SHPO, THPO, or other tribal representativemay request that the EPA place a 

hold on authorization based on concerns about potential adverse impactsto historic properties. The EPA will evaluate

any such request and notify you if any additional information is needed to address adverse impactsto historic properties 

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

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 measuresfor

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

minor source, you must comply with this request and proceed to Step 4.
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2.4 Step 4

Consultation with your applicable SHPO, THPO, or other tribal representative.

If, following your discussions with the appropriate historic preservation authoritiesin Step 5, the applicable SHPO, THPO,

or other tribal representative requests additional information or further consultation, you must respond with such

information or consult to determine impacts and appropriate measures to mitigate such impacts to historic properties

that may be caused by the construction, modification or operation of your new or modified minor source site. If as a 

result of your discussions with the applicable SHPO, THPO, or tribal representative, you enter into, and comply with, a 

written agreement regarding treatment and/or mitigation of impacts on yoursite, then you may indicate this on your

request for coverage and include a copy of the written agreement, and no further screening steps are necessary.

If, however, agreement on an appropriate treatment or mitigation plan cannot be reached between you and the SHPO,

THPO, or other tribal representative within 30 days of your response to the SHPO, THPO, or other tribal

representative’srequest for additional information or further consultation, you may submit your request for coverage,

but you must indicate that you have not negotiatedmeasuresto avoid or mitigate such effects. You must also include

with your request for coverage under the general permit the following documentation:

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.

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.