## United States Environmental Protection Agency

General Permit for New or Modified True Minor Sources of Air Pollution in Indian Country
http://www.epa.gov/air/tribal/tribalnsr.html



## Instructions : Gasoline Dispensing Facilities

Version 1.0

Last Modif i ed: November 14 , 2013

If you wish to notify the reviewing authority o f your intent to operate under the ‘ General Permit for New or
Modified True Minor Source Gasoline Dispensing Facilities in Indian Country

, ’ please complete the form

“ Request for Coverage under the General Permit for New or Modified True Minor Source Gasoline Dispensing
Facilities in Indian Country

. ”

This General Permit implements the requirements of the minor New Source Review (NSR) rule as described

under 40 CFR part 49.

These instructions are intended to provide you with information that may be useful in completing the Request

for Coverage form

. In the form, please provide information on all existing, new or modified units.



### Helpful Definitions f

r om the Federal Indian Country Minor NSR Rule (40 CFR 49.152)

– This is not a comprehensive list.

Modification means any physical or operational change at a source that would cause an increase in the
allowable emissions of the affected emissions units for any regulated NSR pollutant or that would cause the
emission of any regulated NSR pollutant not previously emitted. [ 40 CFR 49.152(d) ]

The following e xemptions apply:

(1) A physical or operational change does not include routine maintenance, repair, or replacement.
(2) An increase in the hours of operation or in the production rate is not considered an operational
change unless such increase is prohibited under any federally

- enforceable permit condition or other
permit condition that is enforceable as a practical matter.
(3) A change in ownership at a source is not considered a modification.

Potential to Emit (PTE) means the maximum capacity of a source to emit a pollutant under its physical and
operational design. Any physical or operational limitation on the capacity of the source to emit a pollutant,
including air pollution control equipment and restrictions on hours of operation or on the type or amount of
material combusted, stored or processed, shall be treated as part of its design if the limitation or the effect
it would have on emissions is enforceable as a practical matter. Secondary emissions, as defined at 40 CFR 52.21(b)(18) of this chapter, do not count in determining the PTE of a source.

Information collected on applications includes the following:



### Secti on 1: Contact Information

1. Business Name: Provide the complete company name. For corporations, include divisions or subsidiary
name, if any.

2. Date: Provide the date you submit the completed application.Instructions: Gasoline Dispensing Page 2 of 4

Version 1.0 3. Site Address: Provide the actual address of where the source is operating or will operate and not the
mailing address. Include the state and the zip code.

4. County: Provide the county in which the source is operating or will operate.

5. Name of Operator or Contact at Sit e: Provide the name of the operator or contact at the site.

6. Phone of Operator or Contact at Site: Provide a telephone number where the operator or contact at the
site can be reached during business hours.

7. Owner: List the full name of the owner of the business.

8. Telephone of Owner: Provide a telephone number where the owner of the business can be reached
during business hours.

9. Mailing Address of Owner: Provide the mailing address of the owner. Include the state a nd the zip code.

10. Correspondence Address: Provide the mailing address of the authorized contact person. Include the

state and the zip code.

11. Authorized Contact Person: Provide the name, title, phone number, email address, and f ax number of

the authorized c ontact person. The authorized contact is the person authorized to receive requests for

data and information.



### Section 2: Facility Information and Technical Information for Submitt ing a Request for Coverage u nder a General Permit

12. Description of Your Gasoline Dispensing Facility: Is your facility new or is this a modification to an
existing facility ? Is this facility a retail facility, or a non

- retail facility? If this is a new request, describe the
proposed new source. If this is a modification, descr ibe the modification proposed.

13. North American Industry Classification System (NAICS)/Standard Industrial Classification (SIC) Code and

Description: Provide the NAICS/SIC Code and/or description for the facility (check all that apply):

 4471 NAICS (Gasoline Stations)

 44711 NAICS (Gasoline Stations without Convenience Stores)

 447110 NAICS (Convenience Stations with Convenience Stores)

 44719 NAICS (Other Gasoline Stations)

 447190 NAICS (Other Gasoline Stations)

 5411 SIC (Grocery Stores)

 5541 SIC (Gasoline Service Stations)

14. Ozone Attainment Status: Indicate if this facility is located in an ozone nonattainment area and specify the classification of the ozone nonattainment area. If part of a tribe’s area is designated as attainment

and ano ther part as nonattainment, the answer to this question should be based on the designation
where the source would be located. If the source straddles the two areas, the more stringent
classification applies. Information on the ozone attainment status of th e area where your facility isInstructions: Gasoline Dispensing Page 3 of 4

Version 1.0 located can be found at: http://www.epa.gov/airquality/greenbook/

. Please contact your reviewing authority if you have questions above an area’s attainment status.

15. Exempt ion from the NSR Minor Program: For a new facility, calculate the PTE of all proposed emission

units and determine if the proposed construction is below the applicability thresholds in the Indian Country Minor NSR program (the thresholds listed in 40 CFR 4 9.153). For a modification to your existing
facility, calculate the emissions increase from your new or modified emission units and determine if the
proposed construction or modification is below the thresholds listed. For a new emissions unit

, the
emissions change is the PTE of the new unit. For a modified emissions units, the emissions change is the
change in allowable emissions of the unit.

You only need to consider the thresholds for nonattainment areas if your source is located in an area
designated nonattainment. If in a nonattainment area, then you only need to consider the nonattainment threshold for the pollutant(s) for which the area is designated nonattainment.

If the PTE of your new facility or the emissions increase at your exist ing facility is below the applicable
thresholds listed for ALL pollutants, the new or modified source is exempt from the NSR minor program.
You do not need a permit for this source. The EPA is providing a PTE calculator to assist with this task.

The calcul ator is available online at : http://www.epa.gov/air/tribal/tribalnsr.html

.

16. Qualification for General Permit

– Facility in Attainment Area : If located in an attainment area, calculate the PTE of your entire facility (include new, modified, and existing units) and determine if the facility is
below the NSR major source threshold of 250 tpy. If the PTE of the proposed facility is equal or above

250 t py for ANY pollutant, this new or modified source does not qualify for this general permit . The EPA
is providing a PTE calculator to assist with this task. The calculator is available online at : http://www.epa.gov/air/tribal/tribalnsr.html

.

17. Qualification for General Permit

– Facility in Nonattainment Area : If located in a nonattainment area, calculate the PTE of your entire facility (include new, modified, and existing units) and determine if the
facility is below the NSR major source thresholds listed. Note the NSR major source classification is
pollutant specific. You only need to consider the nonattainment area thresholds for the particular
pollutant s for which the area is designat ed as nonattainment. If the PTE of the proposed facility is equal

to or above the threshold for ANY pollutant for which the area is designated as nonattainment then this
new or modified source does not qualify for this general permit . The EPA is providing a PTE calculator to

assist with this task. The calculator is available online at : http://www.epa.gov/air/tribal/tribalnsr.html

.

18. 40 CFR 49.162 Requirements: 40 CF R 49.162 specifies the requirements t hat apply to a new or modified
gasoline dispensing facility. Some of these requirements are applicable to sources based on size and
location of storage tanks, gasoline throughput, presence or absence of controls, and if your source is
located in a serious, severe, or extreme ozone nonattainment area. Determine if your source is located
in a serious, severe, or extreme ozone nonattainment area. Examine these requirements and determine
if you are able and willing to comply with them. If you do not believe you can comply with these limits,
you must obtain a site

- specific permit from the reviewing authority

.Instructions: Gasoline Dispensing Page 4 of 4

Version 1.0 

### Section 3 : Information on Compliance with Federal Statu t es Necessary for Requesting Coverage under a General Permit

19. Endangered Species Act: To request coverage under this permit, sources must demonstrate that they
have satisfied the permitting requirements related to the Endangered Species Act. The EPA is providing
procedures with the application to assist with this task.

20. National Historic Preservation Act: To request coverage under this permit, sources must demonstrate
that they have satisfied the permitting r equirements related to the National Historic Preservation Act.
The EPA is providing procedures with the application to as sist with th is task.



### Section 4 : Applicant’s Statement

Certify that the information supplied in the application is correct, then sign the document, print your name, and
date the document in the spaces provided.