PAL-02: REVISED PLANTWIDE APPLICABILITY LIMIT State Form 52452 (11-05) INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT IDEM - Office of Air Quality - Permits Branch 100 N. Senate Avenue Indianapolis, IN 46204 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 revision to an established Plantwide Applicability Limit (PAL). 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 the current PAL permit. • Attach a new BACT analysis and/or NSR permit application (if needed) • 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 request for each PAL revision. 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: Overview of the PAL Revision Specify the reason for this PAL revision. Identify the pollutant that this Plantwide Applicability Limit (PAL) addresses. Calculate the sum of the baseline actual emissions for each emission unit category and attach your calculations behind this form. 1. Reason for PAL Revision: 2. Pollutant (choose one): Increase PAL Limit CO Pb 3. Sum of Baseline Actual Emissions: Other: NOx PM PM10 SO2 VOCM2.5 Attach calculations. Small Units (specify units): Calculations Attached Significant/Major Units (specify units): Calculations Attached New/Modified Units – exceeding the PAL (specify units): Calculations Attached Removed/Modified Units – lowering the PAL (specify units): Calculations Attached PART B: Emission Units Contributing to the PAL Increase (or Decrease) Identify all emission units contributing to the change in the PAL limit and include the potential to emit (PTE) designation. If additional space is needed, you may make a copy of this table. 4. Emission Unit 5. Change to PTE 1. + – tpy 2. + – tpy 3. + – tpy 4. + – tpy 5. + – tpy 6. + – tpy 7. + – tpy 8. + – tpy 9. + – tpy 10. + – tpy 11. + – 6. PTE Designation (small / significant / major) tpy Page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com