Indiana Department of Environmental Management Office of Air Quality Air Permit Application Page 1 of 3 PI-21 Instructions 10/2006 PROCESS INFORMATION: Site Remediation – INSTRUCTIONS Microsoft Word version of PI-21 Adobe PDF version of PI-21 The purpose of PI-21 (state form 52570) is to obtain detailed information about the remediation process. Complete one form for each process unit (or group of identical process units). PI-21 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). Part A: Process Information Part A identifies the remediation process. If there are multiple process units that are identical in nature, capacity, and use, you may use one form to summarize the data for the identical process units. 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. 2. Installation Date: Provide the date on which the process unit was installed. If the exact date is not known, provide the month and year of the installation. If the unit has not yet been installed, provide the anticipated installation date. If the unit has been modified since the original installation, include the most recent modification date. 3. How many identical units are identified in this form? Indicate whether this form identifies one process unit, or a number of identical process units. Identical units must be of the same blasting type, process capacity, and installation date. If more than one identical unit, specify the number of units in the space provided. 4. Method of Remediation: Specify the method of remediation that will be used If none of the listed categories or subcategories is applicable, specify the remediation method under the “other” option. 5. Total Organic Contamination: Provide the total organic contamination to soil or groundwater, and include appropriate units of measure. 6. Estimated Remediation Time: Indicate the time interval that the remediation is expected to operate expressed in days. 7. Maximum Water Flowrate: Provide the maximum rated water flowrate of the remediation system in gallons per minute (gpm). 8. Maximum Air Flowrate: Provide the maximum rated air flowrate of the remediation system in actual cubic feet per minute (acfm). 9. Add-On Control Technology: Identify all control technologies used for this process, if applicable. A Control Equipment (CE) application form will need to be completed for each control device used, and a summary of control equipment should be submitted using form CE-01. 10. Control Techniques: Identify all control techniques used for this process. 11. Process Limitations / Additional Information: Use the space provided to identify any acceptable process limitations or to provide additional information. An American LegalNet, Inc. www.FormsWorkflow.com Indiana Department of Environmental Management Office of Air Quality Air Permit Application Page 2 of 3 PI-21 Instructions 10/2006 example of an acceptable process limitation would be taking a limit on raw material usage. Such a limit would require an additional record keeping and reporting requirements to be enforceable. For some limitations, performance testing may also be required. Any future change to the established limit will require a permit modification. Part B: Emission Factors Part B identifies the emission factors used to calculate air emissions from this process. 12. Process Unit: Identify the process and include the identification number for the unit, if applicable. 13. 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. 14. Emission Factor: Provide the relevant emission factor including the appropriate units (e.g., lb/units, lbs/ton, lbs/gal, lbs/cf, etc.). 15. 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. Part C: Soil / Groundwater Contaminants Part C identifies the soil or groundwater contaminants that are to be removed. 16. Chemical Name: List the chemical name for each contaminant. 17. CAS Number: Provide the Chemical Abstract Series (CAS) registry number for each of the listed contaminants. 18. Concentration: Provide the concentration of each contaminant in micrograms per liter (µg/L) and parts per million (ppm). Part D: Federal Rule Applicability Part D identifies any federal rules that apply to the process. 19. Is a New Source Performance Standard (NSPS) applicable to this source? Specify whether a New Source Performance Standard (NSPS) is applicable to the process unit(s). If a New Source Performance Standard (NSPS) applies, list the rule citation and title in the space provided and submit a FED-01 form to identify the applicable portions of the rule. 20. Is a National Emission Standard for Hazardous Air Pollutants (NESHAP) applicable to this source? Specify whether a National Emission Standard for Hazardous Air Pollutants (NESHAP) is applicable to the process unit(s). If a National Emission Standard for Hazardous Air Pollutants (NESHAP) applies, list the rule citation and title in the space provided and submit a FED-01 form to identify the applicable portions of the rule. The United States Environmental Protection Agency (U.S. EPA) provides lists of NESHAP on the Rules and Implementation section of the Air Toxics Website. 21. Non-Applicability Determination: Provide an explanation of non-applicability if the process unit would appear to be subject to a rule (based on the rule title of affected source category), but the rule will not apply to the process. For example, if the process unit is part of the source category subject to a rule, but the process unit in question is not subject to the rule, state the reason why the unit is not subject. American LegalNet, Inc. www.FormsWorkflow.com Indiana Department of Environmental Management Office of Air Quality Air Permit Application Page 3 of 3 PI-21 Instructions 10/2006 ***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-21: www.in.gov/icpr/webfile/formsdiv/52570.doc 2. Adobe PDF version of form PI-21: www.in.gov/icpr/webfile/formsdiv/52570.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 6. U.S. EPA’s Clearinghouse for Inventories & Emission Factors: www.epa.gov/ttn/chief/index.html 7. Appendix A of AP-42: www.epa.gov/ttn/chief/ap42/appendix/appa.pdf 8. United States Environmental Protection Agency (US EPA): www.epa.gov 9. Rules and Implementation section of U.S. EPA’s Air Toxics Website: www.epa.gov/ttn/atw/eparules.html 10. 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 11. IDEM, OAQ’s information regarding submittal of confidential business information: www.in.gov/idem/permits/air/apps/cbi.html 12. 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-21: Site Remediation State Form 52570 (R / 1-07) INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT 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 • The purpose of this form is to obtain detailed information about the remediation process. Complete one form for each process unit (or group of identical process units). This is a required form. • NOTES: Detailed instructions for this form are available online at www.idem.IN.gov/permits/air/apps/instructions/pi21instructions.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. PART A: Process Information Part A identifies the remediation process. If there are multiple process units that are identical in nature, capacity, and use, you may use one form to summarize the data for the identical process units. 2. Installation Date: 1. Unit ID: (actual or anticipated) 3. How many (identical) process units are identified in this form? One More than one (specify number) : 4. Method of Remediation: Air Sparging Air Stripping Bioremediation 5. Total Organic Contamination (specify units): 6. Estimated Remediation Time (days): 7. Maximum Water Flowrate (gpm): 8. Maximum Air Flowrate (acfm): 9. Add-On Control Technology: Identify all control technologies used for this unit, and attach completed CE-01 (unless “none”). None Wet Scrubber / Absorption – Attach CE-05. Other (specify): – Attach CE-10. 10. Control Techniques: Identify all control techniques used for this process. 11. Process Limitations / Additional Information: Identify any acceptable process limitations. Attach additional information if necessary. This space is intentionally left blank. Continued on next page Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com Indiana Department Of Environmental Management Office Of Air Quality State Form 52570 (R / 1-07) Process Information – Site Remediation FORM PI-21 Page 2 of 2 PART B: Emission Factors Part B identifies all emission factors used to calculate air emissions from this process. 12. Process Unit 13. Air Pollutant 14. Emission Factor (& ID, if applicable) value 15. Source of Emission Factor units (if not using AP-42, include calculations) AP-42 Other AP-42 Other AP-42 Other AP-42 Other AP-42 Other AP-42 Other PART C: Soil / Groundwater Contaminants Part C identifies the soil or groundwater contaminants that are to be removed. 16. Chemical Name: 17. Chemical Abstract Service (CAS) Registry Number 18. Concentration µg/L ppm PART D: Federal Rule Applicability Part D identifies any federal rules that apply to the process. 19. Is a New Source Performance Standard (NSPS) applicable to this source? If yes, attach a completed FED-01 for each rule that applies. 40 CFR Part 60, Subpart Yes No Yes No (Specify): 20. Is the National Emission Standard for Hazardous Air Pollutants (NESHAP) for Site Remediation (40 CFR Part 63, Subpart GGGGG) applicable to this source? Attach a completed FED-01 if this rule is applicable. 21. Non-Applicability Determination: Provide an explanation if the process unit appears subject to a rule (based on the rule title or the source category), but the rule will not apply. American LegalNet, Inc. www.FormsWorkflow.com