EC-02 Emission Credit Registry Transfer Of Emission Credits {51784}

EC-02 EMISSION CREDIT REGISTRY ­ TRANSFER OF EMISSION CREDITS State Form 51784 (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-02 is to provide information regarding the use 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/ec02instructions.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: Pre-Sale EC Owner Information Part A is intended to provide basic information about the owner of the emission credit(s) prior to the transfer. 1. Pre-Sale EC Owner: 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): Part B: Post-Sale EC Owner Information Part B is intended to provide basic information about the new owner of the emission credit(s). 9. Post-Sale EC Owner: 11. Address: City: 12. Name of Contact Person : 13. Title (optional): 14. Telephone Number: ( ) ­ 15. Facsimile Number (optional): ( ) ­ State: ZIP Code: 10. Source ID: 16. Electronic Mail Address (optional): Part C: Summary of Updates to the EC Registry Part C is intended to provide sufficient information to record the transfer of emission credits in order to update the Emission Credit Registry. 17. Date of Transfer 18. Pollutant 19. Reactivity 20. EC Quantity 21. EC IDs Emission Credit Registry (EC-02) Page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com