Facility Information - SCDHEC



PLEASE DO NOT SEND A COPY OF THE INSTRUCTIONS IN WITH YOUR APPLICATION

If you have any questions while filling out this application form, please contact the Bureau of Air Quality, Engineering Services Division by calling (803) 898-4123.

Submit one signed (in blue ink) hard copy to the following address:

Engineering Services Division Director

Bureau of Air Quality

2600 Bull Street

Columbia, South Carolina, 29201

If the facility is making modifications at the facility, information on all existing sources will need to be included in the application and will need to be resubmitted. All information requested on this form should be completely filled out. The applicant should also keep a copy of the completed registration permit application – Fuel Combustion Operations package in their records on site for use by the facility's air permit contact when answering technical questions and to have available to Department Personnel upon request.

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|FACILITY IDENTIFICATION |

|SC Air Permit Number (8-digits only) |Application Date |

|(Leave blank if one has never been assigned) | |

|     -      |      |

|Facility Name |Facility Federal Tax Identification Number |

|(This should be the name used to identify the facility at the physical address |(Established by the U.S. Internal Revenue Service to identify a business |

|listed below) |entity) |

|      |      |

|FACILITY PHYSICAL ADDRESS |

|Physical Address:       |County:       |

|City:       |State: SC |Zip Code:       |

|Facility Coordinates (Facility coordinates should be based at the front door or main entrance of the facility.) |

|Latitude:       |Longitude:       | NAD27 (North American Datum of 1927) |

| | |Or |

| | |NAD83 (North American Datum of 1983) |

|FACILITY'S PRODUCTS / SERVICES |

|Primary Products / Services (List the primary product and/or service) |

|      |

|Primary SIC Code (Standard Industrial Classification Codes) |Primary NAICS Code (North American Industry Classification System) |

|      |      |

|Other Products / Services (List any other products and/or services) |

|      |

|Other SIC Code(s):       |Other NAICS Code(s):       |

|AIR PERMIT FACILITY CONTACT |

|(Person at the facility who can answer technical questions about the facility and permit application.) |

|Title/Position:       |First Name:       |Last Name:       |

|Mailing Address:       |

|City:       |State:       |Zip Code:       |

|E-mail Address:       |Phone No.:       |Cell No.:       |

|OWNER OR OPERATOR |

|Title/Position:       |First Name:       |Last Name:       |

|Mailing Address:       |

|City:       |State:       |Zip Code:       |

|E-mail Address:       |Phone No.:       |Cell No.:       |

|OWNER OR OPERATOR SIGNATURE |

|I certify we meet the criteria established for this Registration Permit for Fuel Combustion Operations and agree to the conditions and terms of this |

|Registration Permit for Fuel Combustion Operations. I certify, to the best of my knowledge and belief, that no applicable standards and/or regulations will be |

|contravened or violated. I certify that any application form, report, or compliance certification submitted in this permit application is true, accurate, and |

|complete based on information and belief formed after reasonable inquiry. I understand that any statements and/or descriptions, which are found to be incorrect,|

|may result in the immediate revocation of any permit issued for this application. |

| |      |

|Signature of Owner or Operator |Date |

|APPLICABILITY |

|The Bureau of Air Quality (BAQ) will determine if a facility meets the criteria to qualify for coverage under this permit. |

|Does the facility only have the following sources: boilers, emergency generators, non-emergency generators, storage tanks, ethylene oxide |Yes No |

|sterilizer (if located at a hospital), and sources exempt as outlined in S.C. Regulation 61-62.1, Section II(B)? | |

|Is the maximum size for any single boiler burning fuels other than natural gas and propane 30 million BTU/hr heat input capacity or less? |Yes No |

|Is the combination of all boilers on site, regardless of the fuels burned, less than 100 million BTU/hr total heat input capacity? |Yes No |

|For boilers, are they equipped with Low NOX burners? | Yes (include copy of manufacture data showing emission’s information for NOX) |

| |No |

| |Not Applicable |

|For boilers, have the burners been replaced since June| Yes (include copy of DHEC form 2935) |

|25, 2004? |No |

| |Not Applicable |

|Are the generators certified by the manufacturer to meet EPA’s non-road diesel engine emission standards/tiers? If yes, include |Yes No |

|documentation with this application showing the generators meet the EPA non-road emission standards/tiers. | |

|Do the non-emergency generators operate 500 hours per year or less? |Yes No |

|For generators, are they equipped with a method to |Yes No |If yes, please indicate how they record the actual hours of use.       |

|record the actual hours of use such as an hour meter? |Not Applicable | |

|Do the fuel combustion sources only burn natural gas, propane, virgin No. 2 fuel oil, virgin diesel, or Biodiesel that meets ASTM D6751? |Yes No |

|Is the sulfur content for all fuels burned equal to or less than 0.05% by weight? |Yes No |

|Has the facility received an exemption to burn any |Yes No |If yes, when was the exemption granted?       |

|fuel other than natural gas, propane, virgin No. 2 |Not Applicable | |

|fuel oil, virgin diesel, or Biodiesel that meets ASTM | | |

|D6751? | | |

|Were the emissions calculated using AP-42, manufacture| AP-42 |

|data, or other method? |Manufacture Data (attach copy) |

| |Other Method (include additional explanation with sample calculations) |

|Is the facility wide potential to emit less than 100 tons per year for each of the following pollutants: PM, PM10, PM2.5, SO2, NOX, CO, and |Yes No |

|VOC? | |

|Is the facility wide potential to emit less than 10 tons per year for any single hazardous air pollutant (HAP) and less than 25 tons per |Yes No |

|year for all combined HAPs? | |

|EQUIPMENT INSTALLED |

|Action |Equipment |Rated Capacity |Units |Description** |Fuels Burned/Stored |Dates |

*Peak Shaving Generators are considered Non-emergency generators

**Should be a brief description of the type of source (examples: fire tube boiler, four-stroke spark ignited engine (Rich Burn), etc.)

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