Form SFN58172 "Fuel Supplier Certification for Distillate Oil (40 Cfr 60, Subpart Dc)" - North Dakota

What Is Form SFN58172?

This is a legal form that was released by the North Dakota Department of Environmental Quality - a government authority operating within North Dakota. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2021;
  • The latest edition provided by the North Dakota Department of Environmental Quality;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form SFN58172 by clicking the link below or browse more documents and templates provided by the North Dakota Department of Environmental Quality.

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Download Form SFN58172 "Fuel Supplier Certification for Distillate Oil (40 Cfr 60, Subpart Dc)" - North Dakota

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FUEL SUPPLIER CERTIFICATION FOR DISTILLATE OIL (40 CFR 60, SUBPART Dc)
NORTH DAKOTA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF AIR QUALITY
SFN 58172 (9-2021)
GENERAL
Name of Firm or Organization
Year of Emissions
Mailing Address
City
State
ZIP Code
Permit to Operate Number
Emission Unit Number(s) Subject to Subpart Dc
Total Oil Combusted (gal)
in Subpart Dc Boilers.
REQUIRED DOCUMENTATION:
Attach fuel supplier certification for all distillate oil combusted during the period. The fuel supplier certifications shall include:
1.
The name of the oil supplier.
2.
A statement from the oil supplier that the oil complies with the following specifications for fuel oil Nos. 1 or 2, as defined by the
American Society for Testing and Materials in ASTM D396-78, 89. 90, 92, 96 or 98 “Standard Specification for Fuel Oils.”
3.
The guaranteed maximum sulfur content by weight of fuel oil delivered to this source.
I declare under the penalties of perjury that this report has been examined by me and to the best of my knowledge is a true, correct and
complete report.
Print Name of Person Submitting Report
Title
Email Address
Signature
Telephone Number
Date
Return completed form to:
North Dakota Department of Environmental Quality
Division of Air Quality
4201 Normandy Street, 2
nd
Floor
Bismarck, ND 58503-1324
(701)328-5188
FUEL SUPPLIER CERTIFICATION FOR DISTILLATE OIL (40 CFR 60, SUBPART Dc)
NORTH DAKOTA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF AIR QUALITY
SFN 58172 (9-2021)
GENERAL
Name of Firm or Organization
Year of Emissions
Mailing Address
City
State
ZIP Code
Permit to Operate Number
Emission Unit Number(s) Subject to Subpart Dc
Total Oil Combusted (gal)
in Subpart Dc Boilers.
REQUIRED DOCUMENTATION:
Attach fuel supplier certification for all distillate oil combusted during the period. The fuel supplier certifications shall include:
1.
The name of the oil supplier.
2.
A statement from the oil supplier that the oil complies with the following specifications for fuel oil Nos. 1 or 2, as defined by the
American Society for Testing and Materials in ASTM D396-78, 89. 90, 92, 96 or 98 “Standard Specification for Fuel Oils.”
3.
The guaranteed maximum sulfur content by weight of fuel oil delivered to this source.
I declare under the penalties of perjury that this report has been examined by me and to the best of my knowledge is a true, correct and
complete report.
Print Name of Person Submitting Report
Title
Email Address
Signature
Telephone Number
Date
Return completed form to:
North Dakota Department of Environmental Quality
Division of Air Quality
4201 Normandy Street, 2
nd
Floor
Bismarck, ND 58503-1324
(701)328-5188