GSD-09 – Summary of Additional Information – INSTRUCTIONS Microsoft Word version of GSD-09 Adobe PDF version of GSD-09 The purpose of GSD-09 (State Form 51611) is to supply a format for providing additional information about a process or emissions unit. You should complete a copy of this form for each set of additional information that you include with your air permit application. If you do not provide the enough information to adequately describe each process or emissions unit, the application process may be stopped. GSD-09 is optional 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). Summary of Additional Information This table summarizes any additional information about a process or emissions unit that you are submitting with your air permit application. 1. Process: Provide a brief description of the process for which you are providing additional information. 2. Unit ID: Provide the identification number for each emissions unit for which you are providing additional information. The identification numbers listed on this form should correspond to the emissions unit identified on the Plant Layout and Process Flow diagrams. 3. Application Form Reference: Provide the number of the OAQ application form as well as each item number for which you are providing additional information. 4. Explanation: Provide a brief explanation of why you are supplementing the application with additional information. This information will help us continue to improve our air permit application forms. 5. Summary of Additional Information: Provide a brief summary of the additional information you are providing with your air permit application. 6. Additional Calculations / Diagrams: Use the space provided to include additional calculations and/or diagrams, if applicable. ***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-09: Summary of Additional Information State Form 51611 (R2 / 9-06) INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT 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 • The purpose of this form is to supply a format for providing additional information about a process or emissions unit. This form is optional. • Detailed instructions for this form are available 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. Summary of Additional Information This table is intended to summarize any additional information about a process or emissions unit that you are submitting with your air permit application. 1. Process: 2. Unit ID: 3. Application Form Reference: 4. Explanation: Provide a brief explanation of why you are supplementing the application with additional information. This information will help us continue to improve our air permit application forms. 5. Summary of Additional Information: Provide a brief summary of the additional information you are providing with your air permit application. 6. Additional Calculations / Diagrams: Use the space provided to include additional calculations and/or diagrams, if applicable. Page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com