GSD-08 – Hazardous Air Pollutant Emissions Summary – INSTRUCTIONS Microsoft Word version of GSD-08 Adobe PDF version of GSD-08 The purpose of GSD-08 (State Form 51604) is to provide the actual and potential emissions of each hazardous air pollutant (HAP) emitted from the source. Indiana does not have de minimis levels for HAPs; therefore, all emissions that can be reasonably quantified must be included on this form. GSD-08 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). Part A: Unit Emissions Summary: Part A provides the actual and potential emissions of each hazardous air pollutant emitted from each emissions unit. If you do not provide the enough information to adequately describe the emissions from 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. 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. 3. Hazardous Air Pollutant: For each emissions unit identified, list each hazardous air pollutant (HAP) emitted to the atmosphere during normal operation. If there are multiple pollutants for an emissions unit, use a new row for each pollutant. For a complete list of HAPs, please refer to the United States Environmental Protection Agency’s (US EPA) Air Toxics Website (ATW) original list of HAPs and list of modifications to the HAPs. 4. CAS No.: Provide the Chemical Abstract Series (CAS) number associated with the hazardous air pollutant, if applicable. 5. Actual Emissions: For each emissions unit specific pollutant identified, provide the actual emissions level based on normal operating conditions (i.e., actual hours of operation, using control equipment, etc.) in standard units and also in tons per year (tpy). Since the units will vary depending on the process, appropriate units must be included or the application process may be stopped. The standard units used for this form should correspond to the units used on form CD-01, Facility/Unit Compliance Status. The annual emissions level should be calculated using data from the previous year of operation and should correspond to the emissions reported on the Annual Emission Statement (if required). It is important to provide an estimate of actual emissions so we can compare this number to the potential to emit. 6. Potential Emissions: For each emissions unit specific pollutant identified, provide the total potential to emit in standard units and also in tons per year (tpy) based on the maximum design capacity of the emissions unit and operating at 8760 hours/year. Since the units will vary depending on the process, appropriate units must be included or the application process may be stopped. The standard units used for this form should correspond to the units used on form CD-01, Facility/Unit Compliance Status. 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 and 365 days per year. 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. Limitations on operations (work practices) or emissions (control equipment) may be included in the calculations only to the extent that the limitations are federally enforceable (required by NSPS, NESHAP, approved SIP requirement, NSR/PSD permit condition, etc.). Limitations that are not federally enforceable cannot be included (state only requirement, local agency permit condition, etc.). American LegalNet, Inc. www.FormsWorkflow.com Part B: Pollutant Emissions Summary: Part B provides the total actual and potential emissions of each hazardous air pollutant emitted from the source (including all emissions units and fugitive emissions at the source). If you do not provide the enough information to adequately describe the total source emissions, the application process may be stopped. 7. Hazardous Air Pollutant: List each hazardous air pollutant emitted to the atmosphere during normal operation of the source. 8. CAS No.: Provide the Chemical Abstract Series (CAS) number associated with the hazardous air pollutant, if applicable. 9. Actual Emissions: Provide the total source-wide actual emissions level for each pollutant based on normal operating conditions (i.e., actual hours of operation, using control equipment, etc.) in standard units and also in tons per year (tpy). Since the units will vary depending on the process, appropriate units must be included or the application process may be stopped. The standard units used for this form should correspond to the units used on form CD-01, Facility/Unit Compliance Status. The annual emissions level should be calculated using data from the previous year of operation and should correspond to the emissions reported on the Annual Emission Statement (if required). It is important to provide an estimate of actual emissions so we can compare this number to the potential to emit. 10. Potential Emissions: Provide the total source-wide potential to emit in standard units and also in tons per year (tpy) based on the maximum design capacity of each emissions unit and operating at 8760 hours/year. Since the units will vary depending on the process, appropriate units must be included or the application process may be stopped. The standard units used for this form should correspond to the units used on form CD-01, Facility/Unit Compliance Status. 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 and 365 days per year. 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. Limitations on operations (work practices) or emissions (control equipment) may be included in the calculations only to the extent that the limitations are federally enforceable (required by NSPS, NESHAP, approved SIP requirement, NSR/PSD permit condition, etc.). Limitations that are not federally enforceable cannot be included (state only requirement, local agency permit condition, etc.). Part C: Fugitive HAP Emissions (If applicable) Part C summarizes the sources of fugitive HAP emissions at the source and estimates HAP emissions from these emission points. Complete this table if you are required to provide fugitive emissions data pursuant to 326 IAC 2-2 or 326 IAC 2-3. Pursuant to 326 IAC 2-2-1(x) and 326 IAC 2-3-1(v), “fugitive emissions” means those emissions that could not reasonably pass through a stack, chimney, vent, or other functionally equivalent opening. 11. Fugitive Emissions Source: Several common sources of fugitive HAP emissions are listed in this column. If there is a source that is not included in this list, provide a name for the fugitive HAP emissions source in the space provided. 12. Hazardous Air Pollutant: Specify the hazardous air pollutant emitted from the fugitive emissions source. 13. Emission Factor: For each fugitive HAP emission source listed, provide a pound per hour (lb/hr) emission factor for estimating fugitive emissions. 14. Number Leaking: For each fugitive HAP emission source listed, quantify the number of leaking emission points. 15. Uncontrolled Potential To Emit: For each fugitive HAP emission source listed, provide the uncontrolled potential to emit in pounds per hour (lb/hr) and tons per year (tpy). ***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 American LegalNet, Inc. www.FormsWorkflow.com 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-08: Hazardous Air Pollutant 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 51604 (R2 / 9-06) INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT • The purpose of this form is to provide the actual and potential emissions of each hazardous air pollutant emitted from the source. 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: Unit Emissions Summary Part A provides the actual and potential emissions of each hazardous air pollutant emitted from each emissions unit. If you do not provide the enough information to adequately describe the emissions from each emissions unit, the application process may be stopped. 1. Unit ID 2. Stack / Vent ID 3. Hazardous Air Pollutant 4. CAS No. 5. Actual Emissions Standard Units Continued on Next Page Tons Per Year 6. Potential To Emit Standard Units Tons Per Year Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com Indiana Department Of Environmental Management Office Of Air Quality State Form 51604 (R2 / 9-06) Air Permit Application FORM GSD-08 Page 2 of 2 Part B: Pollutant Emissions Summary Part B provides the total actual and potential emissions of each hazardous air pollutant emitted from the source (including all emissions units and fugitive emissions at the source). If you do not provide the enough information to adequately describe the total source emissions, the application process may be stopped. 7. Hazardous Air Pollutant 8. CAS No. 9. Actual Emissions Standard Units Tons Per Year 10. Potential To Emit Standard Units Tons Per Year Part C: Fugitive HAP Emissions (if applicable) Part C summarizes the sources of fugitive HAP emissions at the source and estimates HAP emissions from these emission points. Complete this table if you are required to provide fugitive emissions data pursuant to 326 IAC 2-2 or 326 IAC 2-3. 11. Fugitive Emissions Source 12. Hazardous Air Pollutant 13. Emission Factor (lb/hr) 14. Number Leaking 15. Uncontrolled Potential To Emit Pounds Per Hour Tons Per Year Compressor Seals Flanges Open-Ended Lines Pressure Relief Seals Pump Seals Sampling Connections Valves Other (specify): American LegalNet, Inc. www.FormsWorkflow.com