INITIAL NOTIFICATION FORM
| |Iowa Department of Natural Resources |
| |Air Quality Bureau |
| |Notification of Intent to Install Pollution Control Equipment on Reciprocating Internal Combustion Engine (RICE) |
|Instructions: This is an example of the type of information that must be submitted to qualify for the exemption from construction permitting requirements found at|
|567 IAC 22.1(2)”g”. Facilities may submit the information in another form or format, or use this form. |
|This form or equivalent information should be submitted at least 30 days prior to installing control equipment. |
|This form is intended to be used by facilities that plan to install pollution control equipment on a reciprocating internal combustion engineer (RICE). This form |
|cannot be used for other types of changes that may qualify for exemption “g”. |
|Exemption “g” cannot be used by facilities located in Linn County or Polk County. |
Facility Information
|Name of Firm/Company: | |
|Facility Name (if different): | |
|Facility Number (if known): | | |
|Equipment Location - Street: | |
|City: | |State: | |Zip: | |
|Mailing Address (if different): | |
|City: | |State: | |Zip: | |
|Person to Contact: | |
|Phone number: | |Email (if available): | |
Engine Information
|Emission Unit Number: | |Iowa DNR Construction Permit No.: | |
|Emission Unit Description: | |
|Anticipated Installation Date of Control | |Will Stack Location Change? | Yes No |
|Equipment: | | | |
|Stack Height Before Change (feet, from | |Stack Height After Change (feet, from | |
|the ground): | |the ground): | |
|Description of Change (e.g. installing diesel oxidation catalyst): |
| |
|Responsible Official Certification |
| |I certify the truth, accuracy, and completeness of this notification. |
|Responsible Official Name |Responsible Official Signature |Date |
| | | |
Submittal Instructions
Submit this notification to: Iowa Department of Natural Resources, NESHAP Coordinator, 502 E 9th St, Des Moines IA 50319
Be sure to keep a copy of this notification on file at your facility.
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