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 EC-03 EMISSION CREDIT REGISTRY – USE OF EMISSION CREDITS State Form 51785 (6-04) INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT NOTES: • The purpose of EC-03 is to provide information regarding the use of emission credits. This is a required form. • Detailed instructions for this form are available online at http://www.IN.gov/idem/permits/air/apps/instructions/ec03instructions.html. • FOR OFFICE USE ONLY 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 confidential information becoming a public record, available for any one to inspect and photocopy. DATE RECEIVED: Part A: EC User Information Part A is intended to provide basic information about the user of the emission credit(s). 1. EC User: 2. Source ID: 3. Address: City: State: ZIP Code: 4. Name of Contact Person : 5. Title (optional): 6. Telephone Number: ( ) – 7. Facsimile Number (optional): ( ) – 8. Electronic Mail Address (optional): 9. Permit Number Corresponding to the Use of Emission Credits: ___ ______ -- ___________ -- __________ Part B: Summary of Updates to the EC Registry Part B is intended to provide sufficient information to record the use of emission credits and update the Emission Credit Registry. 1. Date of Use Emission Credit Registry (EC-03) 2. Pollutant 3. Reactivity 4. EC Quantity 5. EC IDs Page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com