Southern Ute Indian Tribe

Southern Ute Indian Tribe

https://www.southernute-nsn.gov/justice-and-regulatory/epd/

air-quality/src-review-permit/

Part 1: Submit 30 Days Prior to Beginning Construction -- General Facility Information

FEDERAL IMPLEMENTATION PLAN FOR TRUE MINOR SOURCES IN INDIAN

COUNTRY IN THE OIL AND NATURAL GAS PRODUCTION AND NATURAL

GAS PROCESSING SEGMENTS OF THE OIL AND NATURAL GAS SECTOR

Registration for New True Minor Oil and Natural Gas Sources and Minor

Modifications at Existing True Minor Oil and Natural Gas Sources

Please submit information to:

airquality@southernute-nsn.gov

Or

Southern Ute Indian Tribe

Environmental Programs Department

Air Quality Division

P.O. Box 737 MS #84

Ignacio, CO 81137

A. GENERAL SOURCE INFORMATION (See Instructions Below)

1. Company Name

2. Source Name

3. Type of Oil and Natural Gas Operation

4. New Minor Source?

Yes

5. Minor Source Modification?

No

Yes

6. NAICS Code

7. SIC Code

8. U.S. Well ID(s) or API Number(s) [if applicable]

9. Land Surface Owner (Fee / Tribal / Federal)

10. Area of Indian Country

12a. Latitude

11. County

No

12b. Longitude

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B. CONTACT INFORMATION (See Instructions Below)

1. Owner Name

Title

Mailing Address

Email Address

Telephone Number

Facsimile Number

2. Operator Name (if different from owner)

Title

Mailing Address

Email Address

Telephone Number

Facsimile Number

3. Source Contact

Title

Mailing Address

Email Address

Telephone Number

Facsimile Number

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4. Compliance Contact

Title

Mailing Address

Email Address

Telephone Number

Facsimile Number

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 air pollution control equipment and compliance monitoring devices or activities

that are expected to be used at the facility.

Estimated operating schedules.

If satisfying the requirements under §49.104(a)(1), documentation that another federal agency has complied with its

requirements under the Endangered Species Act (ESA) and the National Historic Preservation Act (NHPA) when

authorizing the activities for the facility/activity covered under this registration. The appropriate documents shall clearly

show that the other federal agency had met its obligations under both the ESA and NHPA. A simple reference to a

Record of Decision or other final decision document will not be acceptable. Examples of acceptable documentation

would be a letter from the U.S. Fish and Wildlife Service field office (for ESA) or a historic preservation office (for

NHPA) stating they agree with the assessment conducted by the other federal agency for the subject project and that the

requirements of those statutes have been met. The documentation shall be submitted within the Part 1 registration.

If satisfying the requirements under §49.104(a)(2), documentation demonstrating that you have completed the required

screening procedures specified for consideration of threatened or endangered species and historic properties. (The

procedures are contained in the following document: “Procedures to Address Threatened or Endangered Species and

Historic Properties for the Federal Implementation Plan for True Minor Sources in Indian Country in the Oil and

Natural Gas Production and Natural Gas Processing Segments of the Oil and Natural Gas Sector,” https://

www.epa.gov/tribal-air/final-federal-implementation-plan-oil-and-natural-gas-true-minor-sources-and-amendments.

Other.

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Instructions for Part 1

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, or location that may contain one

or more air pollution emitting units.

3. Type of Operation: Indicate the generally accepted name for the oil and natural gas production or natural gas

processing segment operation (e.g., oil and gas well site, tank battery, compressor station, natural gas processing

plant).

4. New True Minor Source: [Per Federal Indian Country Minor New Source Review Rule, 40 CFR 49.153].

5. True Minor Source Modification: [Per Federal Indian Country Minor New Source Review Rule, 40 CFR 49.153].

6. North American Industry Classification System (NAICS): The NAICS Code for your oil and natural gas source

can be found at the following link for North American Industry Classification System:

http://www.census.gov/eos/www/naics/.

7. Standard Industrial Classification Code (SIC Code): Although the new NAICS code has replaced the SIC codes,

much of the Clean Air Act permitting processes continue to use these codes. The SIC Code for your oil and

natural gas source can be found at the following link for Standard Industrial Classification Codes:

http://www.osha.gov/pls/imis/sic_manual.html.

8. U.S. Well ID or API Number: Unique well identifier as assigned by the Federal or State oil and gas regulatory

agency with primacy, using the American Petroleum Institute (API) Standard for number format (pre-2014) or the

Professional Petroleum Data Management (PPDM) Association US Well Number Standard (2014-present).

Provide IDs for all oil and natural gas production wells associated with the facility, if applicable. May not be

applicable for downstream production sources, such as compressor stations.

9. Land Surface Owner (Fee / Tribal / Federal): Provide the land surface ownership type. https://

geo.southernute.com/portal/apps/webappviewer/index.html?id=9f4f657453d34d0694282ab1d691c67e

10. Area of Indian Country: Provide the name of the Indian reservation within which the source is operating.

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

12. Latitude & Longitude (12a. and 12b.): Provide latitude and longitude location(s) in decimal degrees, indicating the

datum used in parentheses. These are GPS (global positioning system) coordinates. This information should be

provided in decimal degrees with 6 digits to the right of the decimal point, indicating the datum used in

parentheses (i.e., NAD 27, NAD 83, WGS 84 – WGS 84 is preferred over NAD 27).

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.

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C. Attachments

The information requested in the attachments will enable the Southern Ute Indian Tribe (SUIT) to understand the type of

oil and natural gas source being registered.

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.

Information in these forms submitted in compliance with the final Federal Indian Country Minor New Source Review rule

may be claimed as confidential. A company may assert a claim of confidentiality for information submitted by clearly

marking that information as confidential. Such information shall be treated in accordance with EPA’s procedures for

information claimed as confidential at 40 CFR part 2, subpart B, and will only be disclosed by the means set forth in the

subpart. If no claim of confidentiality accompanies the report when it is received by EPA, it may be made public without

further notice to the company (40 CFR 2.203).

Information in these forms submitted in compliance with the Federal Indian Country Minor New Source Review rule may

be claimed as confidential. A company may assert a claim of confidentiality for information submitted by clearly marking

that information as confidential. Such information shall be submitted and treated in accordance with Reservation Air

Code (RAC) 2-124. If no claim of confidentiality accompanies the report when it is received by the Tribe, it may be made

public without further notice to the company.

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