4Z-01 Initial Notification Report - 40 CFR Part 63 ...



|[pic] |4Z-01 |

| |Initial Notification Report – 40 CFR Part 63, |

| |Subpart ZZZZ |

| |Air Quality Permit Program |

| |Doc Type: Notifications – MACT/Compliance Status |

Initial Notification Report

Reciprocating Internal Combustion Engines

40 CFR Part 63, Subpart ZZZZ (63.6580-63.6675)

An initial notification is required by 40 CFR 63.6645(d) and 40 CFR 63.9(b)(2) for existing major Hazardous Air Pollutant (HAP) sources subject to the conditions of Subpart ZZZZ, Reciprocating Internal Combustion Engines.

If you own or operate an affected source, submit this report by August 16, 2004, or within 120 calendar days after the unit becomes subject to the National Emission Standards for Hazardous Air Pollutants for Reciprocating Internal Combustion Engines, whichever is later.

Please print or type the following information for each source subject to the applicable rule mentioned above.

|1a) AQ Facility ID No.: |      |

|1b) AQ File No.: |      |

Section I - Facility Information (40 CFR 63.9(b)(2)(ii))

|Facility name: |      |

|Street address |      |

|(Physical location of facility): | |

|City: |      |MN |Zip: |      |

|Facility contact name: |      |

|Title: |      |Phone number: |      |

Section II – Owner/Operator Information (40 CFR 63.9(b)(2)(i))

|Owner/Operator name: |      |

|Owner/Operator mailing address: |      |

|City: |      |State: |      |Zip: |      |

Section III – Source Description

Check the box that applies. (§63.9(b)(2)(v))

This facility is an area source of HAP – the facility is not subject to this rule. Records of this determination must remain on site for 5 years.

This facility is a major source of HAP - complete the remaining portions of this form

Note: A major source is a source that emits or has the potential to emit 10 tons per year or more of any one HAP or 25 tons per year or more of any combination of HAPs. All other sources are area sources. The major/area source determination is based on all HAP emission points inside the facility fence line, not just inside the facility itself.

|Anticipated Date of Compliance with 40 CFR pt. 63, Subpart ZZZZ: |      |

Briefly describe the nature, size, design, and method of operation of the source. (§63.9(b)(2)(iv))

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Note: If the same information requested above is contained in a Title V Permit Application or permit, you may attach the relevant pages from that document to this notification and reference those pages above.

Identify the types of emission points within the affected source subject to the relevant standard and the types of hazardous air pollutants emitted. (§63.9(b)(2)(iv))

Types of Emission Points

stationary reciprocating internal combustion engine (except if the stationary RICE is being tested at a stationary RICE test cell/stand)

Note: A stationary RICE is any internal combustion engine which uses reciprocating motion to convert heat energy into mechanical work and which is not mobile. Stationary RICE differ from mobile RICE in that a stationary RICE is not a non-road engine as defined at 40 CFR 1068.30, and is not used to propel a motor vehicle or a vehicle used solely for competition.

Types of HAP Emitted

Please indicate the principal types of HAP emitted by the affected source (i.e. toluene, xylene, xylene (mixed), methylene chloride, methanol, MIBK, cadmium, glycol ethers, etc.)

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Section IV - Certification

I certify under penalty of law that, based on information and belief formed after reasonable inquiry, the statements and information contained or referenced in this initial notification report are true, accurate, and complete.

|Permittee Responsible Official: |Co-Permittee Responsible Official (if applicable) |

|Mr./Ms. |      |Mr./Ms. |      |

|Title: |      |Title: |      |

|Signature: | |Signature: | |

|Date: |      |Date: |      |

Note: The individual signing must meet the definition of “responsible official” in Minn. R. 7007.0100, subp. 21.

|Forward To: |Air Quality Compliance Tracking Coordinator |Mr. George Czerniak, Chief |

| |Minnesota Pollution Control Agency |Air Enforcement & Compliance Assurance Branch |

| |520 Lafayette Road North |EPA Region V |

| |Saint Paul, Minnesota 55155-4194 |77 West Jackson Boulevard |

| | |Chicago, Illinois 60604 |

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