PAL-01: ACTUALS PLANTWIDE APPLICABILITY LIMIT IDEM - Office of Air Quality - Permits Branch 100 N. Senate Avenue Indianapolis, IN 46204 State Form 52451 (11-05) INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT Telephone: (317) 233-0178 or Toll Free: 1-800-451-6027 x30178 (within Indiana) Facsimile Number: (317) 232-6749 http://www.IN.gov/idem/permits/air NOTES: The purpose of this form is to request a Plantwide Applicability Limit (PAL) based on actual emissions. In order to complete your request in a timely manner, please do the following: • Attach this form to your completed application cover sheet and GSD-01. • Attach supplemental information behind this document. • Submit three copies of your completed request to the address in the upper right corner of this document. • Do NOT include any filing fee with the application. IDEM will bill for the PAL fee at the appropriate time. • Complete a separate PAL-01 for each PAL you are requesting. IDEM makes all submitted information available to the public unless submitted under a claim of confidentiality. The applicant must make the claim of confidentiality at the time of submission following the requirements outlined 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: Define the PAL Identify the pollutant that this Plantwide Applicability Limit (PAL) addresses. Calculate the baseline actual emissions, and attach the calculations behind this form. Identify the PAL monitoring system, and include the proposed calculation procedures for converting the monitoring system data using the space provided or as an additional attachment. 1. Pollutant (choose one): CO Pb NOx PM PM10 SO2 2. Baseline Actual Emissions (specify units): VOCM2.5 Attach calculations behind this form. 3. Time Period Used for Determining Baseline: 4. PAL Monitoring System: Attach supplemental information as needed. Mass Balance Calculations: Information Attached CEMS: Information Attached CPMS: Information Attached PEMS: Information Attached Emission Factors (state the source): Information Attached Other (specify): Information Attached 5. Proposed calculation procedures for converting monitoring system data: Choose one: Procedures are attached Procedures are as follows: 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 52451 (11-05) Air Permit Application PAL-01: Actuals Plantwide Applicability Limit Page 2 of 2 PART B: Identify the PAL Emission Units Provide a list of all emission units at the source designated as small, significant, or major based on potential to emit (PTE). Indicate the federal and state applicable requirements, emission limitations, or work practice standards that apply to each unit. If additional space is needed, you may make a copy of this table. 6. Emission Unit 7. PTE 8. PTE Designation (small / significant / major) 9. Average Past Actual Emissions (Baseline) 1. tpy tpy tpy tpy 4. tpy tpy 5. tpy tpy 6. tpy tpy 7. tpy tpy 8. tpy tpy 9. tpy tpy 10. tpy tpy 11. tpy tpy 12. tpy tpy 13. tpy tpy 14. tpy tpy 15. tpy tpy 16. tpy tpy 17. tpy tpy 18. tpy tpy TOTAL: tpy (e.g., mass balance, CEMS, etc.) tpy 3. 11. Applicable Requirements Emissions tpy 2. 10. Basis for Actual tpy tpy Significance Level PAL tpy tpy American LegalNet, Inc. www.FormsWorkflow.com