EC-01 Emission Credit Registry Generation Of Emission Credits {51783}

EC-01 EMISSION CREDIT REGISTRY ­ GENERATION OF EMISSION CREDITS State Form 51783 (6-04) INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT IDEM - Office of Air Quality - Permits Branch 100 N. Senate Avenue P.O. Box 6015 Indianapolis, IN 46206-6015 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 EC-01 is to provide information regarding the generation of emission credits. This is a required form. Detailed instructions for this form are available online at http://www.in.gov/idem/permits/air/apps/instructions/ec01instructions.html. All information submitted to IDEM will be made available to the public unless it is submitted under a claim of confidentiality. Claims of confidentiality must be made at the time the information is submitted to IDEM, and must follow the requirements set out in 326 IAC 17.1-4-1. Failure to follow these requirements exactly will result in your confidential information becoming a public record, available for any one to inspect and photocopy. FOR OFFICE USE ONLY DATE RECEIVED: Part A: EC Generator Information Part A is intended to provide basic information about the generator of the emission credit(s). 1. EC Generator: 3. Address: City: 4. Name of Contact Person : 5. Title (optional): 6. Telephone Number: ( ) ­ 7. Facsimile Number (optional): ( ) ­ State: ZIP Code: 2. Source ID: 8. Electronic Mail Address (optional): 9. Permit Number Corresponding to the Generation of Emission Credits: ___ ______ -- ___________ -- __________ Part B: Summary of Generated Emission Credits Part B is intended to provide sufficient information to register the generation of emission credits in the Emission Credit Registry. 1. Date of Generation 2. Pollutant 3. Reactivity 4. EC Quantity Emission Credit Registry (EC-01) Page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com