Indiana Department of Environmental Management Office of Air Quality Air Permit Application Page 1 of 2 PI-02G Instructions 4/2006 PROCESS INFORMATION: Combustion – Emission Factors – INSTRUCTIONS Microsoft Word version of PI-02G Adobe PDF version of PI-02G The purpose of PI-02G (state form 52541) is to specify the emission factors used to calculate potential to emit from the combustion unit. Complete one form for each combustion unit (or group of identical combustion units). PI-02G is a required form 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 do not provide the enough information to adequately describe the process, 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). Emission Factors This table identifies all emission factors used to calculate potential to emit from the combustion unit. 1. Unit ID: Provide the identification number for the unit. The identification numbers listed on this form should correspond to the emissions unit identified on the Plant Layout and Process Flow diagrams. If there are multiple combustion units that are identical in nature, capacity, and use, you may use one row to summarize the data for the identical combustion units. 2. Air Pollutant: For each process identified, list each air pollutant emitted to the atmosphere during normal operation. If there are multiple pollutants for an process, use a new row for each pollutant. 3. Emission Factor: Provide the relevant emission factor including the appropriate units (e.g., lb/units, lbs/ton, lbs/gal, lbs/cf, etc.). 4. Source of Emission Factor: Provide the source of the emission factors. Common sources include AP-42, stack test data, engineering analysis. The United States Environmental Protection Agency (U.S. EPA) has developed a Clearinghouse for Inventories & Emission Factors containing AP-42 and other emission factors. Appendix A of AP-42 lists several common conversion factors that may be needed to calculate potential to emit. ***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. Summary of Websites 1. Microsoft Word version of form PI-02G: www.in.gov/icpr/webfile/formsdiv/52541.doc 2. Adobe PDF version of form PI-02G: www.in.gov/icpr/webfile/formsdiv/52541.pdf 3. Air Permit Reviewer of the Day (PROD) online form: www.in.gov/idem/permits/air/prodform.html 4. Plant Layout Diagram: www.in.gov/idem/permits/air/apps/instructions/pldexample.pdf 5. Example Process Flow Diagram: www.in.gov/idem/permits/air/apps/instructions/pfdexample.pdf American LegalNet, Inc. www.FormsWorkflow.com Indiana Department of Environmental Management Office of Air Quality Air Permit Application Page 2 of 2 PI-02G Instructions 4/2006 6. U.S. EPA’s Clearinghouse for Inventories & Emission Factors: www.epa.gov/ttn/chief/efinformation.html 7. Appendix A of AP-42: www.epa.gov/ttn/chief/ap42/appendix/appa.pdf 8. Article 17.1, Rule 4, Section 1 of the Indiana Administrative Code (326 IAC 17.1-4-1): www.in.gov/legislative/iac/T03260/A00171.PDF 9. IDEM, OAQ’s information regarding submittal of confidential business information: www.in.gov/idem/permits/air/apps/cbi.html 10. IDEM’s Nonrule Policy Document regarding Emission Data (Air-031-NPD): www.in.gov/idem/rules/policies/index.html American LegalNet, Inc. www.FormsWorkflow.com OAQ PROCESS INFORMATION APPLICATION PI-02G: Combustion – Emission Factors IDEM – Office of Air Quality – Permits Branch 100 N. Senate Ave., MC 61-53 Indianapolis, IN 46204-2251 Telephone: (317) 233-0178, or Toll Free: 1-800-451-6027 x30178 (within Indiana) Facsimile Number: (317) 232-6749 www.idem.IN.gov/permits/air/index.html State Form 52541 (R / 1-07) INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT • The purpose of this form is to specify the emission factors used to calculate potential to emit from the combustion unit. • Complete one PI-02G form for each emissions unit. If there are multiple emission units that are identical in nature, capacity, and use, you may use one PI-02G form to summarize the units. • NOTES: Detailed instructions for this form are available online at www.idem.IN.gov/permits/air/apps/instructions/pi02Ginstructions.doc . • 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 anyone to inspect and photocopy. Emission Factors This table identifies all emission factors used to calculate air emissions from the combustion unit. 1. Unit ID: 2. Air Pollutant: 3. Emission Factor value units 4. Source of Emission Factor (if not using AP-42, include calculations) Carbon Monoxide (CO) AP-42 Other N/A Lead (Pb) AP-42 Other N/A Hazardous Air Pollutant (HAP) (specify): AP-42 Other N/A Nitrogen Oxides (NOX) AP-42 Other N/A Mercury (Hg) AP-42 Other N/A Particulate Matter (PM) AP-42 Other N/A Particulate Matter less than 10μm (PM10) AP-42 Other N/A Particulate Matter less than 2.5μm (PM2.5) AP-42 Other N/A Sulfur Dioxide (SO2) AP-42 Other N/A Volatile Organic Compounds (VOC) AP-42 Other N/A Other (specify): AP-42 Other N/A Other (specify): AP-42 Other N/A Other (specify): AP-42 Other N/A This space was intentionally left blank. Page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com