GSD-04 – Stack / Vent Information – INSTRUCTIONS Microsoft Word version of GSD-04 Adobe PDF version of GSD-04 The purpose of GSD-04 (State Form 51606) is to provide basic information about each stack or vent that has the potential to emit air pollutants. GSD-04 is required for all air 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. 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). Stack / Vent Information This table provides detailed information about each stack or vent that has the potential to emit air pollutants to the atmosphere. If an air stream is vented inside a building, the vent does not need to be listed on this form. Accurate information is needed to determine total potential to emit. If you do not provide the enough information to adequately describe each process vent and/or stack, the application process may be stopped. NOTE: Indiana Law requires permit emission limits to be based on the potential to emit (PTE) air pollutants as if the process was operating at full capacity 24 hours per day, seven (7) days per week. 1. Stack / Vent ID: Provide the identification number for each stack or vent that has the potential to emit air pollutants to the atmosphere. The identification numbers listed on this form should correspond to the stacks and vents identified on the Plant Layout and Process Flow diagrams. 2. Type: Indicate the type of each stack or vent using the following codes: V = Vertical stack H = Horizontal stack W = Wall vent O = Other For each “Other” type listed, provide a brief description of the type of stack or vent in the space provided. 3. Shape: Indicate the physical shape of each stack or vent using the following codes: C = Circular R = Rectangular O = Other For each “Other” shape listed, provide a brief description of the shape in the space provided. 4. Outlet Dimensions: Provide the cross-sectional dimensions in feet (ft) of each stack or vent. For a circular shape, provide the outlet diameter; for a rectangular shape, provide the length and width of the outlet. 5. Height: Provide the total stack or vent height in feet (ft) from the ground level to the highest point of elevation. 6. Maximum Outlet Flow Rate: Provide the maximum outlet flow rate of the airstream in actual cubic feet per minute (acfm). You should also take into consideration the equipment that is venting through the stack or vent. 7. Outlet Gas Temperature: Provide an estimate of the temperature of the airstream in degrees Fahrenheit (°F) just prior to the stack outlet. This number will be used to convert actual flow rate to standard flow rate at 68°F. 8. Related Stacks / Vents: Using the same identification numbers for each stack or vent as is used in Column #1 of this table, indicate the relationship of each stack or vent to other stacks and vents using the following codes: B = Bypass [e.g. S-07 (B)] American LegalNet, Inc. www.FormsWorkflow.com P = Parallel [e.g. S-20 (P)] O = Other [e.g. V-13 (O)] For each “Other” relationship listed, provide a brief description of the relationship in the space provided. ***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 OAQ GENERAL SOURCE DATA APPLICATION GSD-04: Stack / Vent Information IDEM - Office of Air Quality - Permits Branch 100 N. Senate Avenue, Indianapolis, IN 46204-2251 Telephone: (317) 233-0178 or Toll Free: 1-800-451-6027 x30178 (within Indiana) Facsimile Number: (317) 232-6749 www.in.gov/idem/permits/air/index.html State Form 51606 (R2 / 9-06) INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT • The purpose of this form is to provide basic information about each stack or vent that has the potential to emit air pollutants. If you do not provide the enough information to adequately describe each process vent and/or stack, the application process may be stopped. This form is required for all air permit applications. • Detailed instructions for this form are available online at www.in.gov/idem/permits/air/apps/instructions/. • NOTES: 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 public inspection. Stack / Vent Information This table provides detailed information about each stack or vent through which air pollutants could be released into the atmosphere. If an air stream is vented inside a building, the vent does not need to be listed on this form. If additional space is needed, you may make a copy of this form. 1. Stack / Vent ID 2. Type (V H W O) 3. Shape (C R O) 4. Outlet Dimensions (feet) 5. Height (feet) 6. Maximum Outlet Flow Rate (acfm) 7. Outlet Gas Temperature (Degrees F) 8. Related Stacks / Vents (B P O) Page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com