OMB Control No. 2060-0003

OMB Control No. 2060-0003

Approval expires 01/31/2023

Southern Ute Indian Tribe

Address

Phone

Fax

Web address

Reviewing Authority

Program

Address

Phone

Fax

Web address

FEDERAL MINOR NEW SOURCE REVIEW PROGRAM IN INDIAN COUNTRY

Registration for Existing Sources

(FORM REG)

Please submit information to:

[Reviewing Authority

Address

Phone]

A. GENERAL SOURCE INFORMATION

1. Company Name

2. Source Name

3. Type of Operation

4. Portable Source?

5. Temporary Source?

6. NAICS Code

7. SIC Code

Yes

Yes

No

No

8. Physical Address (home base for portable sources)

9. Reservation*

10. County*

11a. Latitude*

11b. Longitude*

12a. Quarter-Quarter Section*

12b. Section*

12c. Township*

12d. Range*

* Provide all locations of operation for portable sources

OMB Control No. 2060-0003

Approval expires 01/31/2023

B. CONTACT INFORMATION

Title

1. Owner Name

Mailing Address

Email Address

Telephone Number

Facsimile Number

2. Operator Name (if different from owner)

Title

Mailing Address

Email Address

Telephone Number

Facsimile Number

Title

3. Source Contact

Mailing Address

Email Address

Telephone Number

Facsimile Number

4. Compliance Contact

Title

Mailing Address

Email Address

Telephone Number

Facsimile Number

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OMB Control No. 2060-0003

Approval expires 01/31/2023

C. ATTACHMENTS

Include all of the following information as attachments to this form

Narrative description of the operations

Identification and description of all emission units and air pollution generating activities (with the exception of

the exempt emissions units and activities listed in §49.153(c)

Identification and description of any existing air pollution control equipment and compliance monitoring

devices or activities

Type and amount of each fuel used

Type raw materials used

Production Rates

Operating Schedules

Any existing limitations on source operations affecting emissions or any work practice standards, where

applicable, for all regulated NSR pollutants at your source.

Total allowable (potential to emit if there are no legally and practically enforceable restrictions) emissions from

the air pollution source for the following air pollutants: particulate matter, PM10, PM2.5, sulfur oxides (SOx),

nitrogen oxides (NOx), carbon monoxide (CO), volatile organic compound (VOC), lead (Pb) and lead compounds,

fluorides (gaseous and particulate), sulfuric acid mist (H2SO4), hydrogen sulfide (H2S), total reduced sulfur (TRS)

and reduced sulfur compounds, including all calculations for the estimates.

Estimates of the total actual emissions from the air pollution source for the following air pollutants: particulate

matter, PM10, PM2.5, sulfur oxides (SOx), nitrogen oxides (NOx), carbon monoxide (CO), volatile organic

compound (VOC), lead (Pb) and lead compounds, ammonia (NH3), fluorides (gaseous and particulate), sulfuric

acid mist (H2SO4), hydrogen sulfide (H2S), total reduced sulfur (TRS) and reduced sulfur compounds, including

all calculations for the estimates.

Other

[Disclaimers] The public reporting and recordkeeping burden for this collection of information is estimated

to average 6 hours per response. Send comments on the Agency’s need for this information, the accuracy of

the provided burden estimates, and any suggested methods for minimizing respondent burden, including

through the use of automated collection techniques to the Director, Collection Strategies Division, U.S.

Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include

the OMB control number in any correspondence. Do not send the completed form to this address.

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OMB Control No. 2060-0003

Approval expires 01/31/2023

D. TABLE OF ESTIMATED EMISSIONS

The following estimates of the total emissions in tons/year for all pollutants contained in your worksheet

stated above should be provided.

H2SO4

Pollutant

Total Actual

Emissions (tpy)

Total Allowable or

Potential Emissions

(TPY)

PM

H2S

TRS

RSC

PM10

PM 2.5

SOx

NOx

CO

VOC

Pb

NH3

Fluorides

Emissions calculations must include fugitive emissions if the source is one the following listed

sources, pursuant to CAA Section 302(j):

(a) Coal cleaning plants (with thermal dryers);

(b) Kraft pulp mills;

(c) Portland cement plants;

(d) Primary zinc smelters;

(e) Iron and steel mills;

(f) Primary aluminum ore reduction plants;

(g) Primary copper smelters;

(h) Municipal incinerators capable of charging more than

250 tons of refuse per day;

(i) Hydrofluoric, sulfuric, or nitric acid plants;

(j) Petroleum refineries;

(k) Lime plants;

(l) Phosphate rock processing plants;

(m) Coke oven batteries;

(n) Sulfur recovery plants;

(o) Carbon black plants (furnace process);

(p) Primary lead smelters;

(q) Fuel conversion plants;

(r) Sintering plants;

(s) Secondary metal production plants;

(t) Chemical process plants

(u) Fossil-fuel boilers (or combination thereof) totaling

more than 250 million British thermal units per hour

heat input;

(v) Petroleum storage and transfer units with a total

storage capacity exceeding 300,000 barrels;

(w) Taconite ore processing plants;

(x) Glass fiber processing plants;

(y) Charcoal production plants;

(z) Fossil fuel-fired steam electric plants of more that

250 million British thermal units per hour heat input,

and

(aa) Any other stationary source category which, as of

August 7, 1980, is being regulated under section 111

or 112 of the Act.

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OMB Control No. 2060-0003

Approval expires 01/31/2023

Instructions

Please answer all questions. If the item does not apply to the source and its operations write “n/a”. If

the answer is not known write "unknown".

A. General Source Information

1. Company Name: Provide the complete company name. For corporations, include divisions or subsidiary

name, if any.

2. Source Name: Provide the source name. Please note that a source is a site, place, location, etc… that may

contain one or more air pollution emitting units.

3. Type of Operation: Indicate the generally accepted name for the operation (i.e., asphalt plant, gas station, dry

cleaner, sand & gravel mining, oil and gas well site, tank battery, etc.).

4. Portable Source: Does the source operate in more than one location? Some examples of portable sources

include asphalt batch plants and concrete batch plants.

5. Temporary Source: A temporary source, in general, would have emissions that are expected last less than 2

years. Do you expect to cease operations within the next 2 years?

6. NAICS Code: North American Industry Classification System. The NAICS Code for your source can be

found at the following link  North American Industry Classification System

(http://www.census.gov/epcd/naics/nsic2ndx.htm#S1).

7. SIC Code: Standard Industrial Classification Code. Although the new North American Industry

Classification System (NAICS) has replaced the SIC codes, much of the Clean Air Act permitting processes

continue to use these codes. The SIC Code for your source can be found at the following link  Standard

Industrial Classification Code (http://www.osha.gov/pls/imis/sic_manual.html).

8. Physical Address: Provide the actual address of where the source is operating, not the mailing address.

Include the State and the ZIP Code.

9. Reservation: Provide the name of the Indian reservation within which the source is operating.

10. County: Provide the County within which the source is operating.

11a & 11b. Latitude & Longitude: These are GPS (global positioning system) coordinates. This information

can be provided in decimal format or degree-minute-second format.

12a – 12d. Section-Township-Range: Please provide these coordinates in Quarter-Quarter

Section/Section/Township/Range. (e.g., SW ¼, NE ¼ /S36/T10N/R21E).

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OMB Control No. 2060-0003

Approval expires 01/31/2023

B. Contact Information

Please provide the information requested in full.

1. Owners: List the full name (last, middle initial, first) of all owners of the source.

2. Operator: Provide the name of the operator of the source if it is different from the owner(s).

3. Source Contact: The source contact must be the local contact authorized to receive requests for data and

information.

4. Compliance Contact: The compliance contact must be the local contact responsible for the source’s

compliance with this rule. If this is the same as the Source Contact please note this on the form.

C. Attachments

The information requested in the attachments will enable SUIT to understand the type

of source being registered and the nature and extent of the air pollutants being emitted.

D. Total Emissions

1. Allowable Emissions (See also, Potential to Emit): Emissions rate of a source calculated

using the maximum rated capacity of the source (unless the source is subject to practically

and legally enforceable limits which restrict the operating rate, or hours of operation, or

both) and the most stringent of the following:

a) Any applicable standards as set forth in 40 CFR parts 60 and 61;

b) Any applicable Tribal or Federal Implementation Plan emissions limitation, including

those with a future compliance date; or

c) Any emissions rate specified as a federally enforceable permit condition, including

those with a future compliance date.

2. Potential to Emit: The maximum capacity of a source to emit a pollutant under its physical

and operational design. Any physical or operational limitation on the capacity of the

source to emit a pollutant, including air pollution control equipment and restrictions on

hours of operation or on the type or amount of material combusted, stored, or processed,

shall be treated as part of its design if the limitation or the effect it would have on

emissions is enforceable as a practical matter. See Allowable Emissions.

Actual Emissions: Estimates of actual emissions must take into account equipment, operating

conditions, and air pollution control measures. For a source that operated during the entire calendar

year preceding the initial registration submittal, the reported actual emissions typically should be the

annual emissions for the preceding calendar year, calculated using the actual operating hours,

production rates, in-place control equipment, and types of materials processed, stored, or combusted

during the preceding calendar year. However, if you believe that the actual emissions in the preceding

calendar year are not representative of the emissions that your source will actually emit in coming

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OMB Control No. 2060-0003

Approval expires 01/31/2023

years, you may submit an estimate of projected actual emissions along with the actual emissions from

the preceding calendar year and the rationale for the projected actual emissions. For a source that has

not operated for an entire year, the actual emissions are the estimated annual emissions for the current

calendar year.

3. The emission estimates can be based upon actual test data or, in the absence of such data,

upon procedures acceptable to the Reviewing Authority. The following procedures are

generally acceptable for estimating emissions from air pollution sources:

(i) Source-specific emission tests;

(ii) Mass balance calculations;

(iii) Published, verifiable emission factors that are applicable to the source. (i.e., manufacturer

specifications).

(iv) Other engineering calculations; or

(v) Other procedures to estimate emissions specifically approved by the Reviewing Authority.

4. Guidance for estimating emissions can be found at http://www.epa.gov/ttn/chief/efpac/index.html.

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