CD-01: Emissions Unit Compliance Status – INSTRUCTIONS Microsoft Word version of CD-01 Adobe PDF version of CD-01 The purpose of CD-01 (state form 51861) is to identify the requirements that apply to each emissions unit at the permitted source and to determine the compliance status of these emissions units. CD-01 is a required form for all Title V permit applications submitted to IDEM, OAQ. For the purposes of this form, the term “source” refers to the plant as a whole and NOT to the individual emissions units. NOTE: The Compliance Determination forms, CD-01 through CD-04, are required for a "complete" application under the Part 70 Permitting Program (Title V) per 326 IAC 2-7-4(c), paragraphs (4), (11), (12), and (14). These forms must be completed for each initial Title V permit application as well as each modification and every renewal. If you have any questions, contact the Air Permit Reviewer of the Day (PROD) at (317) 233-0178 or 1-800-451-6027 extension 3-0178 (toll free call within Indiana). Part A: Identification of Source and Emissions Unit Part A identifies the source and the emissions unit. For the purposes of this form, the term “source” refers to the plant site as a whole and NOT to individual emissions units. 1. Source Name: Provide the legal name of the company that will be used to conduct official business with this source. 2. Source ID: The source identification (ID) number consists of a three (3) digit county code and a five (5) digit source code separated by a dash (-). Sources that have been previously permitted with the OAQ should have received a source ID from our office. If you are planning to construct an entirely new source, you will not yet have a source ID, so you will need to put the words “Not Applicable” on this line. If you think you have a source ID, but you are not sure, contact the Air Permit Reviewer of the Day (PROD) at (317) 233-0178 or 1-800-451-6027 extension 3-0178 (toll free call within Indiana). 3. Emissions Unit Description: Briefly describe the emissions unit. The description should be complete enough that an inspector can easily identify this emissions unit at your source (e.g., South Boiler, Spray Booth #2, etc.). 4. Unit ID: Provide the identification number for each emissions unit. The identification numbers listed on this form should correspond to the emissions unit identified on the Plant Layout diagram and Process Flow diagram. Part B: Regulatory Compliance Status Part B identifies the regulatory requirements that apply to the emissions unit and to determine the compliance status of the emissions unit. These “regulatory requirements” are those required by federal, state, or local law. List the requirements applicable to this source. Such requirements could include existing permit requirements, such as periodic stack testing, restrictions on throughput or operational hours, total solvent usage, etc. Indicate if the requirements are State or Local agency requirements and if the emissions unit is in compliance. List any reporting activities required by permit, order, statute, or rule regarding compliance that are not addressed elsewhere in the application. If you need additional space, attach a separate page and label the page FORM CD-01, Emissions unit Compliance Status. 5. Rule Cite: Provide the citation of the applicable requirements determined to be applicable to this emissions unit. 6. Description: Briefly describe the applicable requirement. Examples are NSPS (New Source Performance Standard), NESHAP (National Emission Standard for Hazardous Air Pollutants), SIP requirement, NSR/PSD permit condition, etc. 7. State/Local only: If the applicable requirement is a state or local agency requirement, then place an "X" here. 8. Limitation: Provide the actual limitation stated in the applicable requirement. American LegalNet, Inc. www.FormsWorkflow.com 9. Test Method: If the applicable requirement requires the use of a specific test method, provide the test method. If no test method is required, place "N/A" here. 10. In Compliance (Y / N): Indicate whether the emissions unit is in compliance with the applicable requirement. Simply place a "y" or "n" in this column. Part C: Compliance Status – Other Requirements Part C identifies any other requirements that apply to the emissions unit and to determine the compliance status of the emissions unit. These “other requirements” would not be required by federal, state, or local law. List any activities that are known to be subject to new requirements during the term of the proposed permit. Consider new requirements on emissions, monitoring, record keeping, testing or test methods, and reporting. If you need additional space, attach a separate page and label the page FORM CD-01, Emissions unit Compliance Status. 11. Other Requirement: Briefly describe the requirement. 12. State/Local only: If the applicable requirement is a state or local agency requirement, then place an "X" here. 13. In Compliance (Y / N): Indicate whether the emissions unit is in compliance with the applicable requirement. Simply place a "y" or "n" in this column. ***SUBMISSION OF CONFIDENTIAL RECORDS*** All information submitted to IDEM will be made available to the public unless it is submitted under a claim of confidentiality. Claim 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 confidential information becoming a public record, available for public inspection. To ensure that your information remains confidential, refer to the IDEM, OAQ information regarding submittal of confidential business information. For more information on confidentiality for certain types of business information, please review IDEM’s Nonrule Policy Document Air-031-NPD regarding Emission Data. American LegalNet, Inc. www.FormsWorkflow.com CD-01 – EMISSIONS UNIT COMPLIANCE STATUS 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 State Form 51861 (8-04) INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT NOTES: • • • • The purpose of CD-01 is to identify the requirements that apply to each emissions unit at the permitted source and to determine the compliance status of these emissions units. This is required form for each initial Title V permit application as well as each modification and every renewal. Detailed instructions for this form are available online at http://www.in.gov/idem/permits/air/apps/instructions/cd01instructions.html. 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: Identification of Source and Emissions Unit Part A is intended to identify the source and the emissions unit. For the purposes of this form, the term “source” refers to the plant site as a whole and NOT to individual emissions units. 1. Source Name: 2. Source ID: 3. Emissions Unit Description: ___-_____ 4. Unit ID: PART B: Regulatory Compliance Status Part B is intended to identify the regulatory requirements that apply to the emissions unit and to determine the compliance status of the emissions unit. These “regulatory requirements” are those required by federal, state, or local law. 5. Rule Cite 7. State / Local Only 6. Description 8. Limitation 9. Test Method 10. In Compliance (y/n) PART C: Compliance Status – Other Requirements Part C is intended to identify any other requirements that apply to the emissions unit and to determine the compliance status of the emissions unit. These “other requirements” would not be required by federal, state, or local law. 11. Other Requirements Emissions Unit Compliance Status (CD-01) 12. State / Local Only 13. In Compliance (y/n) Page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com