"Compliance Certification for New Boilers" - Massachusetts

Compliance Certification for New Boilers is a legal document that was released by the Massachusetts Department of Environmental Protection - a government authority operating within Massachusetts.

Form Details:

  • Released on March 1, 2020;
  • The latest edition currently provided by the Massachusetts Department of Environmental Protection;
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Download "Compliance Certification for New Boilers" - Massachusetts

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Massachusetts Department of Environmental Protection
Environmental Results Program
MassDEP Facility ID# (if known)
Compliance Certification
For New Boilers
Facility AQ # (if known)
A. Facility Information
Important: When
1. Facility Location:
filling out forms
on the computer,
use only the tab
Facility Name
key to move your
cursor - do not
use the return
Street Address
key.
City
State
Zip Code
Federal Employer ID # (FEIN) – NOTE: Please do not use a Social Security Number.
2. Mailing Address & Contact Information:
Street Address/P.O. Box
City
State
Zip Code
Telephone Number
Fax Number
Contact Person Name
Contact Person Title
Contact Person Email Address
B. Facility Emissions Information
This section is for informational purposes only.
If the installation of this boiler causes your facility-wide emissions to exceed an existing emissions cap contained in
one or more of the following:
Limited Plan Application (LPA) or Comprehensive Plan Application (CPA) - 310 CMR 7.02
Restricted Emission Status (RES) - 310 CMR 7.02(9)
50% / 25% Facility Emission Cap Notification - 310 CMR 7.02(11)
Contact the appropriate MassDEP regional office:
https://www.mass.gov/service-details/massdep-regional-offices-by-community
C. Boiler Information
Complete and submit a Compliance Certification form for each new boiler subject to the Environmental Results
Program (ERP) for Boilers (i.e. with a heat input rating of between 10 million and 40 million BTU per hour and
installed after September 14, 2001). Answer all questions. IMPORTANT NOTE: Answering NO to certain questions
requires completion of the Return to Compliance form. In these cases, the notation “RTC” appears next to NO.
Date Installed
Manufacturer of Unit
Company Name
Date (MM/DD/YYYY)
Boiler Serial #
Boiler Model
Name or Number
Number
Facility’s Boiler
Maximum Heat Input
ID
Million BTU Per Hour
Name or Number
boilcert • March 2020
Compliance Certification: New Boilers • Page 1 of 4
Massachusetts Department of Environmental Protection
Environmental Results Program
MassDEP Facility ID# (if known)
Compliance Certification
For New Boilers
Facility AQ # (if known)
A. Facility Information
Important: When
1. Facility Location:
filling out forms
on the computer,
use only the tab
Facility Name
key to move your
cursor - do not
use the return
Street Address
key.
City
State
Zip Code
Federal Employer ID # (FEIN) – NOTE: Please do not use a Social Security Number.
2. Mailing Address & Contact Information:
Street Address/P.O. Box
City
State
Zip Code
Telephone Number
Fax Number
Contact Person Name
Contact Person Title
Contact Person Email Address
B. Facility Emissions Information
This section is for informational purposes only.
If the installation of this boiler causes your facility-wide emissions to exceed an existing emissions cap contained in
one or more of the following:
Limited Plan Application (LPA) or Comprehensive Plan Application (CPA) - 310 CMR 7.02
Restricted Emission Status (RES) - 310 CMR 7.02(9)
50% / 25% Facility Emission Cap Notification - 310 CMR 7.02(11)
Contact the appropriate MassDEP regional office:
https://www.mass.gov/service-details/massdep-regional-offices-by-community
C. Boiler Information
Complete and submit a Compliance Certification form for each new boiler subject to the Environmental Results
Program (ERP) for Boilers (i.e. with a heat input rating of between 10 million and 40 million BTU per hour and
installed after September 14, 2001). Answer all questions. IMPORTANT NOTE: Answering NO to certain questions
requires completion of the Return to Compliance form. In these cases, the notation “RTC” appears next to NO.
Date Installed
Manufacturer of Unit
Company Name
Date (MM/DD/YYYY)
Boiler Serial #
Boiler Model
Name or Number
Number
Facility’s Boiler
Maximum Heat Input
ID
Million BTU Per Hour
Name or Number
boilcert • March 2020
Compliance Certification: New Boilers • Page 1 of 4
Massachusetts Department of Environmental Protection
Environmental Results Program
MassDEP Facility ID# (if known)
Compliance Certification
For New Boilers
Facility AQ # (if known)
C. Boiler Information
(continued)
No – Skip to Section D
Yes
Is the new boiler replacing an old boiler?
Natural Gas
#2 Distillate Fuel Oil
What fuel(s) did the old boiler primarily burn?
#4 Fuel Oil
#6 Residual Fuel Oil
Solid Fuel
D. Compliance Information
Yes
No
1.
Is the boiler equipped with an automated
combustion control system?
Definitions in Workbook
2a.
Natural Gas
Distillate Fuel Oil (Natural Gas
On or before July 1, 2009, the new boiler will
Supply Unavailable)
burn: (Check only one)
Workbook Section 2.1
Both Natural Gas &
Distillate Fuel Oil
After July 1, 2009, the owner/operator will only
Natural Gas
Ultra Low Sulfur Distillate Fuel
2b.
accept delivery for burning in the new boiler:
Oil (ULSD)
(Check only one)
Both Natural Gas &
ULSD
No – Submit RTC Plan
Does the boiler, as designed and installed,
Yes
3.
meet the emissions limitations specified in
310 CMR 7.26(33)
Workbook Section 2.2
No – Submit RTC Plan
Do you have manufacturer documentation on-
Yes
4.
site that the boiler - as designed and when
operated according to the manufacturer's
instructions - will comply with the above
emission limitations?
Workbook Section 2.2
No – Submit RTC Plan
5.
Have you established procedures to ensure that
Yes
the boiler and appurtenances are operated in
accordance with the manufacturer’s standard
operating procedures?
No – Submit RTC Plan
Have you established procedures to ensure that
Yes
6.
the boiler will receive an annual tune-up as
required by 310 CMR 7.26(34) for the life of the
equipment?
Workbook Section 2.3
boilcert • March 2020
Compliance Certification: New Boilers • Page 2 of 4
Massachusetts Department of Environmental Protection
Environmental Results Program
MassDEP Facility ID# (if known)
Compliance Certification
For New Boilers
Facility AQ # (if known)
D. Compliance Information
(continued)
No – Submit RTC Plan
7.
Have you established procedures to
Yes
maintain on-site records for at least three (3)
years?
Workbook Section 2.4
Yes – Skip to 10
No – Answer 9 through 9b
8.
Is the stack is at least 1.5 times the height of
the building and greater than the height of all
adjacent structures?
Definitions in Workbook
No – Submit RTC Plan
Was an EPA guideline air quality model run to
Yes
9.
document that stack emissions will not exceed
National Ambient Air Quality Standards?
Workbook Section 2.5
No – Submit RTC Plan
Did the analysis demonstrate that stack
Yes
9a.
emissions do not cause a violation of National
Ambient Air Quality Standards?
No – Submit RTC Plan
Will air quality model documentation be kept
Yes
9b.
on site for as long as the boiler(s) is
operational?
Is the stack exhaust flow vertical and
Yes
No
10.
unrestricted by a rain protection device?
Workbook Section 2.5
Have you established procedures to ensure
Yes
No
11.
that source registration will be filed as required
by 310 CMR 7.12?
Workbook Section 1.3
Do you discharge boiler blowdown to a
Yes
No
13.
sewer?
Yes – Cease
No
13.
Do you discharge boiler blowdown to a septic
discharge & submit
system?
RTC Plan.
No – Skip to Question 15
14.
Do you discharge boiler blowdown to surface
Yes
water?
No – Submit a RTC Plan
Do have a permit to discharge boiler
Yes
14a.
blowdown to surface water?
No – Skip to Question 16
15.
Do you discharge boiler blowdown to the
Yes
ground or groundwater?
No – Submit a RTC Plan
Do you have permit to discharge boiler
Yes
15a.
blowdown to the ground or groundwater?
No – Skip to Section E
Do you store boiler blowdown in a holding
Yes
16.
tank or container?
No – Submit a RTC Plan
16a.
Yes
Have you submitted a holding tank
compliance certification or received a plan
approval?
boilcert • March 2020
Compliance Certification: New Boilers • Page 3 of 4
Massachusetts Department of Environmental Protection
Environmental Results Program
MassDEP Facility ID# (if known)
Compliance Certification
For New Boilers
Facility AQ # (if known)
E. Certification Statement
“I attest under the pains and penalties of perjury:
Signature
I.
That I have personally examined and am familiar
Print First Name
with the information contained in this submittal,
including any and all documents accompanying
Print Last Name
this certification statement;
II. That, based on my inquiry of those individuals
Title
responsible for obtaining the information, the
information contained in this submittal is, to the
Date of Certification (MM/DD/YYYY)
best of my knowledge, true, accurate, and
complete;
Source of Signatory Authority:
III. That systems to maintain compliance are in
place at the facility and will be maintained even
If a Corporation:
if processes or operating procedures are
President
changed; and
IV. That I am fully authorized to make this
Secretary
attestation on behalf of this facility.
Treasurer
I am aware that there are significant penalties,
Vice President
(if authorized by corporate vote)
including, but not limited to, possible fines and
imprisonment, for willfully submitting false,
Representative of the above
(if authorized by
inaccurate, or incomplete information.
corporate vote and if responsible for overall operation of
the facility)
If a Partnership:
General Partner
If a Sole Proprietorship:
Proprietor
If a Municipality or Public Agency:
Principal Executive Officer
Ranking Elected Official
(empowered to enter into
contracts on behalf of the municipality or public agency)
KEEP A COPY OF THIS COMPLETED FORM AND THE RETURN TO COMPLIANCE FORM, IF
REQUIRED, FOR YOUR FILES. MAIL THE ORIGINAL FORM(S) TO:
MassDEP - ERP - Boiler
P.O. Box 120-165
Boston, MA 02112-0165
boilcert • March 2020
Compliance Certification: New Boilers • Page 4 of 4
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