AEF-01 – ALTERNATE EMISSION FACTOR REQUEST State Form 51860 (8-04) INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT • NOTES: IDEM - Office of Air Quality - Permits Branch 100 N. Senate Avenue, P.O. Box 6015 Indianapolis, IN 46206-6015 Telephone: (317) 233-0178 or Toll Free: 1-800-451-6027 x30178 (within Indiana) Facsimile Number: (317) 232-6749 http://www.IN.gov/idem/permits/air The purpose of this application is to request to use an alternate emission factor for permitting determinations, estimating source emissions for billing, or for development of emission inventories for use in air quality planning. This is required form. • Detailed instructions for this form are available online at http://www.in.gov/idem/rules/policies/air/nrpd014.pdf. • All information submitted to IDEM will be made available to the public unless it is submitted under a claim of confidentiality. Claims of confidentiality must be made at the time the information is submitted to IDEM, and must follow the requirements set out in 326 IAC 17.1-4-1. Failure to follow these requirements exactly will result in your information becoming a public record, available for any one to inspect and photocopy. FOR OFFICE USE ONLY PERMIT NUMBER: ____ ______ – _________ – ____________ PART A: Process Identification Part A is intended to identify the process at the source for which the alternate emission factor is requested. 1. Process Description: 2. Affected Emissions Units: 3. Affected Control Devices: 4. Raw Materials Impacting Emissions: PART B: Standard Calculation Method Part B is intended to identify the standard emission calculation method and to identify why the method is not adequate. 5. Standard Emission Calculation Method: 6. Rationale: Briefly explain why the published emission factor does not appropriately represent the process, operation, or pollution control equipment efficiently. Alternate Emission Factor Request Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT OFFICE OF AIR QUALITY State Form 51860 (8-04) Alternate Emission Factor Request FORM AEF-01 PART C: Proposed Alternate Emission Factor Part C is intended to identify the proposed alternate emission factor (AEF) and to sufficiently describe the AEF such that IDEM staff can understand the process used to develop the AEF. 7. Proposed AEF: Briefly describe the proposed alternate emission factor. 8. AEF Development Method: What approach was, or will be used to develop the alternate emission factor? Continuous Emissions Monitoring System (CEMS) A. Is the CEM certified by IDEM? Yes No B. Is the CEM operated and maintained in accordance with the applicable regulations? Yes No Yes No B. Was testing published and validated through peer review? Yes No C. Was testing approved by IDEM? Yes No Yes No Source Testing A. Was testing conducted by a trade association or industry group? Identify the trade association or industry group: Development of Material Balance Equations Emission Modeling Engineering Estimates Other – Please Specify: 9. Supporting Data: Have you attached the data supporting the development of your alternate emission factor? 10. RM/TP Submittal: Have you submitted the appropriate reference method or test protocol to IDEM? Yes No NA 11. Modeling Analysis: Was any modeling conducted? Yes No NA 12. Modeling Summary: Briefly describe any modeling that was conducted. Attach additional information using form GSD-05, Summary of Additional Information, as needed. Alternate Emission Factor Request Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com