EIQ Form 3.0 (MO780-1509) "Emissions Fee Calculation" - Missouri

What Is EIQ Form 3.0 (MO780-1509)?

This is a legal form that was released by the Missouri Department of Natural Resources - a government authority operating within Missouri. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on December 1, 2015;
  • The latest edition provided by the Missouri Department of Natural Resources;
  • 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 printable version of EIQ Form 3.0 (MO780-1509) by clicking the link below or browse more documents and templates provided by the Missouri Department of Natural Resources.

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MISSOURI DEPARTMENT OF NATURAL RESOURCES
AIR POLLUTION CONTROL PROGRAM
EMISSIONS INVENTORY QUESTIONNAIRE, OR EIQ
FORM 3.0 EMISSIONS FEE CALCULATION
FACILITY NAME
FIPS COUNTY NO.
PLANT NO.
YEAR OF DATA
Use one row to list the emissions from one emission unit. Sum the emissions in the page total box at the
1.
bottom of the column. If more than one page is needed, use the first row of the duplicated page to list the
EMISSION UNIT NO.
page totals from this page. Express figures in tons per year and round to two decimal places.
SCC
AIR POLLUTANT
PM
PM
SO
NO
NH
VOC
CO
LEAD
HAPs
2.5
10
X
X
3
PAGE TOTALS
Note: Fill out the lower portion of this form one time only.
2. ACTUAL EMISSIONS (Use the sum of all page totals for each pollutant for actual emission figures below.)
PM
PM
SO
NO
VOC
CO
LEAD
HAPs
NH
2.5
10
X
X
3
Total
Copy the actual emissions from section 2 to the appropriate box(es) in the Total Plant Emissions Section of
Form 1.0 General Plant Information.
3. CHARGEABLE EMISSIONS (Maximum 4,000 Tons/Yr. cap per pollutant)
NO FEES
NO FEES
NO FEES
Total
FOR
FOR
FOR CO
PM
NH
2.5
3
4. SUM OF CHARGEABLE EMISSIONS SUBJECT TO FEES
Round chargeable emissions to the nearest whole ton. The minimum emission
Tons/Yr.
tonnage is one ton, and the maximum is 12,000 tons per year.
5. TOTAL ANNUAL EMISSIONS FEE
Multiply the sum of chargeable emissions as calculated in section 4 by $48 and enter
$
this amount in section 5. The minimum fee is $48.
6. ANNUAL EMISSIONS FEE REMITTED TO THE CITY OF KANSAS CITY OR ST. LOUIS COUNTY LOCAL AIR AGENCY
CHECK NUMBER
CHECK DATE
AMOUNT REMITTED IN CALENDAR YEAR OF RECORD
7. ANNUAL EMISSIONS FEE REMITTED TO THE STATE (SECTION 5 MINUS SECTION 6)
CHECK NUMBER
CHECK DATE
CHECK AMOUNT
$
8. INCLUDE A CHECK FOR THE AMOUNT IN SECTION 7, PAYABLE TO THE MISSOURI AIR POLLUTION CONTROL PROGRAM.
Mail the check for the emissions fee to the State Air Agency listed on Form 1.0.
9. SEND THE COMPLETED QUESTIONNAIRE AND ANY SUPPORTING DOCUMENTATION TO THE AGENCY LISTED AT THE
BOTTOM OF FORM 1.0 GENERAL PLANT INFORMATION.
MO 780-1509 (12-15)
MISSOURI DEPARTMENT OF NATURAL RESOURCES
AIR POLLUTION CONTROL PROGRAM
EMISSIONS INVENTORY QUESTIONNAIRE, OR EIQ
FORM 3.0 EMISSIONS FEE CALCULATION
FACILITY NAME
FIPS COUNTY NO.
PLANT NO.
YEAR OF DATA
Use one row to list the emissions from one emission unit. Sum the emissions in the page total box at the
1.
bottom of the column. If more than one page is needed, use the first row of the duplicated page to list the
EMISSION UNIT NO.
page totals from this page. Express figures in tons per year and round to two decimal places.
SCC
AIR POLLUTANT
PM
PM
SO
NO
NH
VOC
CO
LEAD
HAPs
2.5
10
X
X
3
PAGE TOTALS
Note: Fill out the lower portion of this form one time only.
2. ACTUAL EMISSIONS (Use the sum of all page totals for each pollutant for actual emission figures below.)
PM
PM
SO
NO
VOC
CO
LEAD
HAPs
NH
2.5
10
X
X
3
Total
Copy the actual emissions from section 2 to the appropriate box(es) in the Total Plant Emissions Section of
Form 1.0 General Plant Information.
3. CHARGEABLE EMISSIONS (Maximum 4,000 Tons/Yr. cap per pollutant)
NO FEES
NO FEES
NO FEES
Total
FOR
FOR
FOR CO
PM
NH
2.5
3
4. SUM OF CHARGEABLE EMISSIONS SUBJECT TO FEES
Round chargeable emissions to the nearest whole ton. The minimum emission
Tons/Yr.
tonnage is one ton, and the maximum is 12,000 tons per year.
5. TOTAL ANNUAL EMISSIONS FEE
Multiply the sum of chargeable emissions as calculated in section 4 by $48 and enter
$
this amount in section 5. The minimum fee is $48.
6. ANNUAL EMISSIONS FEE REMITTED TO THE CITY OF KANSAS CITY OR ST. LOUIS COUNTY LOCAL AIR AGENCY
CHECK NUMBER
CHECK DATE
AMOUNT REMITTED IN CALENDAR YEAR OF RECORD
7. ANNUAL EMISSIONS FEE REMITTED TO THE STATE (SECTION 5 MINUS SECTION 6)
CHECK NUMBER
CHECK DATE
CHECK AMOUNT
$
8. INCLUDE A CHECK FOR THE AMOUNT IN SECTION 7, PAYABLE TO THE MISSOURI AIR POLLUTION CONTROL PROGRAM.
Mail the check for the emissions fee to the State Air Agency listed on Form 1.0.
9. SEND THE COMPLETED QUESTIONNAIRE AND ANY SUPPORTING DOCUMENTATION TO THE AGENCY LISTED AT THE
BOTTOM OF FORM 1.0 GENERAL PLANT INFORMATION.
MO 780-1509 (12-15)