OPERATING SITE INFORMATION Briefly describe the proposed new operation and/or any change(s) to the facility: Directions to the facility: ATTACHMENTS AND SUPPORTING DOCUMENTS I have enclosed the following required documents: Check payable to WVDEP – Division of Air Quality with the appropriate application fee (per 45CSR13 and 45CSR22). Check attached to front of application. I wish to pay by electronic transfer. Contact for payment (incl. name and email address): I wish to pay by credit card. Contact for payment (incl. name and email address): $500 (Construction, Modification, and Relocation) $300 (Class II Administrative Update) $1,000 NSPS fee for 40 CFR60, Subpart IIII and/or JJJJ1 $2,500 NESHAP fee for 40 CFR63, Subpart ZZZZ 2 1 Only one NSPS fee will apply. 2 Only one NESHAP fee will apply. The Subpart ZZZZ NESHAP fee will be waived for new engines that satisfy requirements by complying with NSPS, Subparts IIII and/or JJJJ. NSPS and NESHAP fees apply to new construction or if the source is being modified. Responsible Official or Authorized Representative Signature (if applicable) Facility Location – Attachment A Single Source Determination Form – Attachment B Siting Criteria Waiver (if applicable) – Attachment C Current Business Certificate – Attachment D Process Flow Diagram – Attachment E Process Description – Attachment F Plot Plan – Attachment G Area Map – Attachment H G50-C Section Applicability Form – Attachment I CBP Affected Source Sheet – Attachment J APCD Affected Source Sheet – Attachment K CBP Capture System Sheet – Attachment L CBP Storage and Handling Sheet – Attachment M Storage Vessel Data Sheet – Attachment N Haulroad Emissions – Attachment O Internal Combustion Engine Data Sheet(s) (include manufacturer performance data sheet(s) if applicable) – Attachment P Natural Gas Fired Fuel Burning Unit(s) Data Sheet (Heaters, Boilers if applicable) – Attachment Q Emissions Calculations – Attachment R CBP Emissions Summary Sheet – Attachment S Facility Wide PTE Summary Sheet – Attachment T Class I Legal Advertisement – Attachment U One (1) paper copy and two (2) copies of CD or DVD with pdf copy of application and attachments All attachments must be identified by name, divided into sections, and submitted in order. A – FACILITY LOCATION ATTACHMENT
ATTACHMENT J – CONCRETE BATCH PLANT AFFECTED SOURCE SHEET Complete this data sheet for the concrete batch plant. Concrete Batch Plant Production Information Source Identification Number1 Manufacturer & Model Number Date of Manufacture Maximum Design Production Rate2 cubic yards/hour Maximum Annual Production3 cubic yards/year Daily Operation hours/day Annual Operation days/year hours/year Approximate Percentage of Operation from: Jan - Mar April - June July - Sept Oct - Dec Enter the appropriate Source Identification Number for each concrete batch plant production weigh hopper or central mixer. Batch plant weigh hopper should be designated WH-1, WH-2, etc. Batch plant central mixer should be designated CM-2, etc. Enter the manufacturer’s Maximum Design Production Rate of the concrete batch plant production equipment. Enter the Maximum Annual Production of the concrete batch plant. To calculate Maximum Annual Production, multiply the Maximum Design Production Rate (yd3/hr) by the Annual Operation (hrs/yr). ATTACHMENT K – AIR POLLUTION CONTROL DEVICE AFFECTED SOURCE SHEET
2. Enter storage tank Status using the following: EXIST Existing Equipment NEW Installation of New Equipment REM Equipment Removed 3. Enter storage tank content such as lube oil, diesel, etc. 4. Enter the maximum design storage tank volume in gallons. ATTACHMENT – HAULROAD EMISSIONS Complete this data sheet for paved and unpaved haulroads Haulroad Type Uncontrolled Emissions Controlled Emissions Hourly (lb/hr) Annual (tpy) Hourly (lb/hr) Annual (tpy) Paved Unpaved ATTACHMENT P – Complete this data sheet for each internal combustion engine at the facility. Include manufacturer performance data sheet(s) or any other supporting document if applicable. Use extra pages if necessary. Generator(s) and microturbine generator(s) shall also use this form. Emission Unit ID#1 Engine Manufacturer/Model Manufacturers Rated bhp/rpm Source Status2 Date Installed/ Modified/Removed/Relocated3 Engine Manufactured /Reconstruction Date4 Check all applicable Federal Rules for the engine (include EPA Certificate of Conformity if applicable)5 40CFR60 Subpart JJJJ JJJJ Certified? 40CFR60 Subpart IIII IIII Certified? 40CFR63 Subpart ZZZZ NESHAP ZZZZ/ NSPS JJJJ Window NESHAP ZZZZ Remote Sources 40CFR60 Subpart JJJJ JJJJ Certified? 40CFR60 Subpart IIII IIII Certified? 40CFR63 Subpart ZZZZ NESHAP ZZZZ/ NSPS JJJJ Window NESHAP ZZZZ Remote Sources 40CFR60 Subpart JJJJ JJJJ Certified? 40CFR60 Subpart IIII IIII Certified? 40CFR63 Subpart ZZZZ NESHAP ZZZZ/ NSPS JJJJ Window NESHAP ZZZZ Remote Sources Engine Type6 APCD Type7 ENGINE