OAQ General Source Data Application GSD-01 Basic Source level Information {50640}

GSD-01 ­ Basic Source Level Information ­ INSTRUCTIONS Microsoft Word version of GSD-01 Adobe PDF version of GSD-01 The purpose of GSD-01 (State Form 50640) is to provide essential information about the entire source of air pollutant emissions. GSD-01 is a required form for all air permit applications submitted to IDEM, OAQ. For the purposes of this form, the term "source" refers to the plant as a whole and NOT to the individual emissions units. If you have any questions, contact the Air Permit Reviewer of the Day (PROD) at (317) 233-0178 or 1-800-451-6027 extension 3-0178 (toll free call within Indiana). Part A: Source / Company Location Information Part A gathers information about the location of the source of air pollutant emissions. The questions in this section refer to the plant site, or "source", of air emissions. 1. Source / Company Name: Provide the legal name of the company or plant that will be used to conduct official business with this source. 2. Plant ID: The plant identification (ID) number consists of a three (3) digit county code and a five (5) digit source code separated by a dash (-). Sources that have been previously permitted with the OAQ should have received a plant ID from our office. If you are planning to construct an entirely new source, you will not yet have a plant ID, so you will need to put the words "Not Applicable" on this line. If you think you have a plant ID, but you are not sure, contact the air permit reviewer of the day at (317) 233-0178 or 1-800-451-6027 extension 3-0178 (toll free call within Indiana). 3. Location Address: Provide the address where the source is located. This may or may not be the mailing address. For new source construction, provide the address of the site where the source will be located. 4. County Name: Provide the name of the county where the source is located. For new source construction, provide the county where the source will be located. 5. Township Name: Provide the name of the township where the source is located. For new source construction, provide the township where the source will be located. 6. Geographic Coordinates: Provide the latitude and longitude of the source. This information may be obtained from United States Geological Survey (USGS) maps. 7. Universal Transversal Mercator Coordinates (if known): Universal Transversal Mercator (UTM) coordinates describe the exact location of the source. They can be obtained from the USGS or the Indiana Department of Natural Resources (IN-DNR). Zone 16 is a fixed UTM number for Indiana. 8. Adjacent States: Is this source located within 50 miles of an adjacent state? Indicate whether or not the source is located within fifty (50) miles of the border of a state adjacent to Indiana. If yes, identify the state(s) whose border is within 50 miles of this source. [Illinois (IL), Michigan (MI), Ohio (OH), or Kentucky (KY)]. 9. Attainment Area Designation: Is this source located within a non-attainment area for any one of the criteria air pollutants? Indicate whether the source is located within a non-attainment area for any one of the criteria air pollutants. If yes, identify the pollutants for which this source is considered to be in a non-attainment area. [Ozone (O3) ­ regulated as volatile organic compounds (VOC), nitrogen dioxide (NO2) ­ regulated as nitrogen oxides (NOx), sulfur dioxide (SO2), particulate matter (PM), particulate matter less than 10 microns (PM10), particulate matter less than 2.5 microns (PM2.5), carbon monoxide (CO), and lead (Pb)]. For additional information regarding Indiana Nonattainment areas, please refer to 40 CFR 81.315 or the IDEM, OAQ webpage regarding Attainment of Air Quality Standards. 10. Portable / Stationary: Is this a portable or stationary source? Indicate whether the source is "portable" or "stationary" by checking the appropriate box. A portable source is defined in 326 IAC 2-1.1-1(15), and a new portable source is defined in 326 IAC 2-1.1-1(9). The American LegalNet, Inc. www.FormsWorkflow.com permitting rules concerning portable sources are codified in 326 IAC 2-14. A stationary source is defined in 326 IAC 2-3-1(aa). Part B: Source Summary Part B gathers information about the current and recent status of the source. 11. Internet Address: (Optional) Provide the Internet address (website) for the source. 12. Company Name History: Has this source operated under any other name(s)? Indicate whether the source has recently changed its legal name. For the purposes of this question, "recently" means within the last twelve (12) months, or since this source last applied for an air permit or modification. If the legal name of the company has changed, complete Part I, Company Name History, to provide more details on the previous names used and to specify the name that should be used on official documents issued by IDEM. OAQ. 13. Portable Source Location History: Will the location of the portable source be changing in the near future? This question only applies to portable sources. The permitting rules concerning portable sources are codified in 326 IAC 2-14. Stationary sources cannot "relocate"; therefore, any stationary source that moves to a new location is considered a new source and must comply with the applicable new source construction rules in 326 IAC 2-5.1. Indicate whether the portable source will be moving to a new location. If applicable, complete Part J, Portable Source Location History, to provide all previous locations. If applicable, complete Part K, Request to Change Location of Portable Source, to provide the current and future locations. 14. Existing Approvals: Have any exemptions, registrations, or permits been issued to this source? Check "No" if this application is for an initial air permit. Check "Yes" if the source has applied for and received approval for any other air construction or operating permits in Indiana. List these permits and their corresponding emissions units in Part M: Existing Approvals. If you do not know whether an air permit has been previously issued for your source, contact the air permit reviewer of the day at (317) 233-0178 or 1-800-451-6027 extension 3-0178 (toll free call within Indiana). 15. Unpermitted Emissions Units: Does this source have any unpermitted emissions units? Check "No" if there are no existing unpermitted emissions units at the source and no new construction has taken place subsequent to last issued air permit for this source; otherwise check "Yes". This question also applies