GSD-05 – Emissions Unit Information – INSTRUCTIONS Microsoft Word version of GSD-05 Adobe PDF version of GSD-05 The purpose of GSD-05 (State Form 51610) is to provide basic information about each emissions unit that has the potential to emit air pollutants. GSD-05 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). Emissions Unit Information This table provides detailed information about each emissions unit that has the potential to emit air pollutants to the atmosphere. If you do not provide the enough information to adequately describe each emissions unit, the application process may be stopped. 1. 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 and Process Flow diagrams. 2. Model Number: Provide the model number of the emissions unit. 3. Serial Number: Provide the manufacturer’s serial number for the emissions unit, if applicable. 4. 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.). 5. Manufacturer: Provide name of the manufacturer of the emissions unit. This information is used to assist inspectors in identifying specific pieces of equipment at this source. 6. Installation Date: Provide the date this piece of equipment was installed at this source. An accurate installation date is needed to determine the regulations and/or performance standards that apply to this piece of equipment. 7. Maximum Capacity: Provide the maximum hourly processing capacity of this emission unit. This is generally the rated design performance of the emission unit. Since the capacity units will vary depending on the process, appropriate units must be included or the application process may be stopped. Accurate information is needed to determine total potential to emit. 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. It is important to provide the actual hours of operation so we can compare the potential to emit with actual estimated emissions. Some sources may opt to take a limit on the potential to emit for the entire source, or individual processes, in order to better reflect the actual operating scenario. For a boiler, the maximum capacity is usually expressed as millions of British thermal units per hour (MMBtu/hr). Other commonly used units for hourly capacity include million cubic feet (MMCF), pounds (lbs) of board, tons of scrap, etc. Maximum capacity may not be applicable to some units if PTE is not calculated using the capacity of the unit (e.g. wood milling equipment). If this is the case, you may enter "N/A" in the space provided. 8. Stack / Vent ID: Provide the identification number for each stack or vent to which this emissions unit exhausts. The identification numbers listed on this form should correspond to the stacks and vents identified on the Plant Layout and Process Flow diagrams. ***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 American LegalNet, Inc. www.FormsWorkflow.com 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-05: Emissions Unit 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 51610 (R2 / 9-06) INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT • The purpose of this form is to provide basic information about each emissions unit that has the potential to emit air pollutants. 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. Emissions Unit Information This table provides detailed information about each emissions unit that has the potential to emit air pollutants to the atmosphere. Accurate information is needed to determine the total potential to emit. If you do not provide the enough information to adequately describe each emissions unit, the application process may be stopped. If additional space is needed, you may make a copy of this form. 1. Unit ID 2. Model No. 3. Serial No. 4. Description 5. Manufacturer 6. Installation Date 7. Maximum Capacity 8. Stack / Vent ID Page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com