PAL-04 Request For Termination Of Plantwide Applicability Limit
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PAL-04 Request For Termination Of Plantwide Applicability Limit Form. This is a Indiana form and can be use in Department Of Enviromental Management Statewide.
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Tags: PAL-04 Request For Termination Of Plantwide Applicability Limit, 52454, Indiana Statewide, Department Of Enviromental Management
PAL-04: REQUEST FOR TERMINATION OF PLANTWIDE
APPLICABILITY LIMIT
State Form 52454 (11-05)
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
NOTES:
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
The purpose of this form is to request termination or revocation of 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 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 request.
•
Complete a separate request for each PAL termination request.
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 date the current PAL permit was issued, the expiration date, the pollutant that this Plantwide Applicability Limit
(PAL) addressed, and the proposed PAL Level.
1. Issuance Date of current PAL permit:
2. Expiration Date of current PAL permit:
3. Pollutant (choose one):
CO
Pb
NOx
PM
PM10
SO2
VOCPM2.5
4. PAL Level (specify units):
PART B: Proposed Allowable Emission Limitations (Optional)
Propose an allowable emission limitation for each emission units included in the previously issued PAL. If additional
space is needed, you may make a copy of this table.
5. Emission Unit
6. PTE Designation
(small / significant / major)
7. Proposed Allowable Emission
Limitation (specify units)
8. Applicable
Requirements
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
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