GSD-06 – Particulate Emissions Summary – INSTRUCTIONS Microsoft Word version of GSD-06 Adobe PDF version of GSD-06 The purpose of GSD-06 (State Form 51612) is to provide basic information about each source of particulate emissions. GSD-06 is required for all air permit applications submitted to IDEM, OAQ. For the purposes of this form, the term “source” refers to individual emissions points or groups of emissions points. If you do not provide the enough information to adequately describe each source of particulate emissions, the application process may be stopped. 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: Summary of Particulate Emissions Part A provides a summary of the type and amount of particulate emissions at the source. The state rules on particulate emissions are found in Title 326 of the Indiana Administrative Code, Article 6, Particulate Rules. Emissions Point Information: 1. Emissions Point ID: You must assign a unique identification number to each source of particulate emissions at your plant. The identification numbers listed on this form should correspond to the emissions points identified on the Plant Layout and Process Flow diagrams. NOTE: Many sources begin the numbering their particulate emissions sources wherever the numbering of stacks and vents ended. For example, if fourteen (14) stacks and vents were identified, it makes sense to begin numbering the particulate emissions sources at fifteen [e.g. P-15]. If appropriate, sources of particulate emissions may be grouped together and given a common number. For example, particulate emissions from service valves, flanges, or pumps may be grouped together by the process area since there are typically several service valves, flanges, and/or pumps for each process, and the task of identifying each source separately would be very cumbersome. 2. Emissions Point Description: Provide a brief description of the source of particulate emissions. Potential to Emit 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, 365 days per year. For additional information on how to estimate the PTE from each source of particulate emissions, please refer to the United States Environmental Protection Agency’s (U.S. EPA) Clearinghouse for Inventories & Emission Factors. 3. Particulate Matter: Estimate the total potential to emit (PTE) in tons per year (tpy) for each particulate matter (PM) emissions source. 4. Particulate Matter Less Than Ten Microns: Estimate the total potential to emit (PTE) in tons per year (tpy) for each source of particulate matter emissions less than ten microns (PM-10). 5. Particulate Matter Less Than Two and Five Tenths Microns: Estimate the total potential to emit (PTE) in tons per year (tpy) for each source of particulate matter emissions less than two and five tenths microns (PM-2.5). 6. Total Suspended Particulates: Estimate the total potential to emit (PTE) in tons per year (tpy) for each source of total suspended particulate (TSP) emissions. 7. Fugitive Dust: Estimate the total potential to emit (PTE) in tons per year (tpy) for each fugitive dust emissions source. 8. Fugitive Particulate Matter: Estimate the total potential to emit (PTE) in tons per year (tpy) for each fugitive PM emissions source. 9. Particulate Matter Also Classified as a Hazardous Air Pollutant: Estimate the total potential to emit (PTE) in tons per year (tpy) for each source of particulate matter emissions that is also classified as a hazardous air pollutant (HAP PM). American LegalNet, Inc. www.FormsWorkflow.com Part B: Control of Particulate Emissions Part B provides information about the measures used to control particulate emissions. Air Permitting Rules 326 IAC 6-4 and 326 IAC 6-5 require fugitive dust to be controlled as needed to prevent dust from visibly crossing property lines. Use this table to identify the measures that will be implemented for controlling fugitive emissions from the permitted operations. 10. Emissions Point ID: List each emissions point identified in Parts A and B above. 11. Control Measures: Check all that apply. (E.g., no control, dust suppression, etc.) 12. Control Measure Description: Provide a brief description of the source of fugitive emissions control measures. The description should included frequency as well as a description of the control measure. Example: “watering scrap yard as needed but no less than once per week. 13. Control Plan: Has a fugitive dust control plan been submitted? If yes, include the date when the plan was submitted. Air Permitting Rules 326 IAC 6-4 and 326 IAC 6-5 require fugitive dust to be controlled as needed to prevent dust from visibly crossing property lines. Parts C and D summarize sources of fugitive particulate emissions from process operations and unpaved roads. Part C: Fugitive Dust (If applicable) Part C identifies measures implemented for controlling fugitive particulate emissions from process operations and unpaved roads. 14. Dust Control Plans: Identify the areas where fugitive dust may be an issue. Common examples are conveying operations, storage or stock piles, and unpaved roads. Check the boxes as applicable to further describe the process (e.g., Are the conveying operations wet or dry?). 15. Control Measures: For each source of fugitive dust identified, describe the measures that will be taken to minimize fugitive dust. Part D: Vehicular Traffic on Unpaved Roads (If applicable) Part D gathers information on vehicular traffic patterns when the site contains unpaved roads. All data should be provided assuming peak hours of vehicular traffic. Two one-way trips equal one round trip. For external traffic (vehicles entering and leaving the property lines), the distance from the plant to the property line is the one-way trip distance. 16. Average Silt Content of Unpaved Roads: Provide the average silt content of all unpaved roads at the source. 17. Vehicle Description: List the vehicles that will travel on the unpaved roads. 18. Maximum Number of Round Trips at Peak Hours: Estimate the number of round trips the vehicle will take on the unpaved road during peak hours of travel. Provide this value in units of trips per hour. 19. Distance of One-Way Trip: Specify the distance of the one-way trip that the vehicle will take on the unpaved road during peak hours of travel. Provide this value in units of miles per trip. 20. Maximum Vehicle Speed: Specify the maximum vehicle speed in units of miles per hour (mph). 21. Maximum Gross Vehicle Weight: Specify the maximum gross vehicle weight, when the vehicle is fully loaded, in tons. 22. Tare Weight: Specify the tare weight of the vehicle in tons. American LegalNet, Inc. www.FormsWorkflow.com 23. Number of Wheels on Vehicle: Specify the number of wheels on the vehicle. ***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-06: Particulate Emissions Summary 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 51612 (R2 / 9-06) INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT • The purpose of this form is to provide basic information about each source of particulate emissions. 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. Part A: Particulate Matter Emissions Part A provides a summary of the type and amount of particulate emissions at the source. The state rules on particulate emissions are found in Title 326 of the Indiana Administrative Code, Article 6, Particulate Rules. If you do not provide the enough information to adequately describe each source of particulate emissions, the application process may be stopped. If additional space is needed, you may make a copy of this table. Emissions Point 1. ID 2. Description Potential To Emit (tons per year) 3. PM 4. PM-10 5. PM-2.5 Continued on Next Page 6. TSP 7. Fugitive Dust 8. Fugitive PM 9. HAP PM Page 1 of 3 American LegalNet, Inc. www.FormsWorkflow.com Indiana Department Of Environmental Management Office Of Air Quality State Form 51612 (R2 / 9-06) Air Permit Application FORM GSD-06 Page 2 of 3 Part B: Control of Particulate Emissions Part C gathers information about how each source of particulate emissions is controlled. If you do not provide the enough information to adequately describe how each source of particulate emissions is controlled, the application process may be stopped. If additional space is needed, you may make a copy of this table. 10. Emissions Point ID 11. Control Measure No Control Dust Suppression 12. Control Measure Description 13. Control Plan No Yes Date Submitted: Other: No Control Dust Suppression No Yes Date Submitted: Other: No Control Dust Suppression No Yes Date Submitted: Other: No Control Dust Suppression No Yes Date Submitted: Other: No Control Dust Suppression No Yes Date Submitted: Other: No Control Dust Suppression No Yes Date Submitted: Other: No Control Dust Suppression No Yes Date Submitted: Other: No Control Dust Suppression No Yes Date Submitted: Other: American LegalNet, Inc. www.FormsWorkflow.com Indiana Department Of Environmental Management Office Of Air Quality State Form 51612 (R2 / 9-06) Air Permit Application FORM GSD-06 Page 3 of 3 Air Permitting Rules 326 IAC 6-4 and 326 IAC 6-5 require fugitive dust to be controlled as needed to prevent dust from visibly crossing property lines. Parts C and D summarize sources of fugitive particulate emissions from process operations and unpaved roads. PART C: Fugitive Dust (if applicable) Part C identifies measures implemented for controlling fugitive particulate emissions from process operations and unpaved roads. 14. Dust Control Plans: Check all that apply. 15. Control Measures: Conveying: Wet Dry Stock Piles: Open Covered Unpaved Roads: Watered? Yes No Other (specify): Other (specify): Other (specify): PART D: Vehicular Traffic on Unpaved Roads (if applicable) Part D gathers information on vehicular traffic patterns when the site contains unpaved roads. All data should be provided assuming peak hours of vehicular traffic. Two one-way trips equal one round trip. For external traffic (vehicles entering and leaving the property lines), the distance from the plant to the property line is the one-way trip distance. 16. Average Silt Content of Unpaved Roads: 17. Vehicle Description 18. Max. No. round trips at peak hours (trips/hr) 19. Distance of oneway trip (miles/trip) 20. Max. vehicle speed (mph) 21. Max. gross vehicle weight (fully loaded) (tons) 22. Tare weight (tons) 23. No. of wheels on vehicle (wheels) American LegalNet, Inc. www.FormsWorkflow.com