Form MO780-2184 "Performance Test Plan" - Missouri

What Is Form MO780-2184?

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

Form Details:

  • Released on January 1, 2013;
  • 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 fillable version of Form MO780-2184 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
PERFORMANCE TEST PLAN
Submit complete form and all attachments to:
Missouri Department of Natural Resources
Air Pollution Control Program, Enforcement Section
P.O. Box 176, Jefferson City, MO 65102
DATE SUBMITTED
ATTENTION
PROPOSED TEST DATE
Test date must be agreed to by Air Pollution Control Program.
1. FACILITY INFORMATION
NAME
ADDRESS
CITY
STATE
ZIP CODE
CONTACT PERSON
TITLE
TELEPHONE NUMBER WITH AREA CODE
CELL PHONE NUMBER
2. AIR POLLUTION SOURCE TO BE TESTED
TYPE OF FACILITY/SOURCE
PERMIT NUMBER
FIPS/PLANT ID
PORT NUMBER
ADDRESS
DIRECTIONS TO SOURCE (OR ATTACH MAP)
INITIAL START-UP DATE
REASON FOR TEST
Condition of Permit
Consent Agreement
Administrative Order
Other (specify)
3. TESTING FIRM INFORMATION
NAME OF FIRM
ADDRESS
CITY
STATE
ZIP CODE
CONTACT PERSON
CONTACT PERSON TITLE
TELEPHONE NUMBER WITH AREA CODE
CELL PHONE NUMBER WITH AREA CODE
NUMBER OF EMPLOYEES OF FIRM
NUMBER OF EMPLOYEES ENGAGED IN AIR POLLUTION SOURCE TESTING
Attach organizational chart with names and titles of personnel.
780-2184 (01-13)
MISSOURI DEPARTMENT OF NATURAL RESOURCES
AIR POLLUTION CONTROL PROGRAM
PERFORMANCE TEST PLAN
Submit complete form and all attachments to:
Missouri Department of Natural Resources
Air Pollution Control Program, Enforcement Section
P.O. Box 176, Jefferson City, MO 65102
DATE SUBMITTED
ATTENTION
PROPOSED TEST DATE
Test date must be agreed to by Air Pollution Control Program.
1. FACILITY INFORMATION
NAME
ADDRESS
CITY
STATE
ZIP CODE
CONTACT PERSON
TITLE
TELEPHONE NUMBER WITH AREA CODE
CELL PHONE NUMBER
2. AIR POLLUTION SOURCE TO BE TESTED
TYPE OF FACILITY/SOURCE
PERMIT NUMBER
FIPS/PLANT ID
PORT NUMBER
ADDRESS
DIRECTIONS TO SOURCE (OR ATTACH MAP)
INITIAL START-UP DATE
REASON FOR TEST
Condition of Permit
Consent Agreement
Administrative Order
Other (specify)
3. TESTING FIRM INFORMATION
NAME OF FIRM
ADDRESS
CITY
STATE
ZIP CODE
CONTACT PERSON
CONTACT PERSON TITLE
TELEPHONE NUMBER WITH AREA CODE
CELL PHONE NUMBER WITH AREA CODE
NUMBER OF EMPLOYEES OF FIRM
NUMBER OF EMPLOYEES ENGAGED IN AIR POLLUTION SOURCE TESTING
Attach organizational chart with names and titles of personnel.
780-2184 (01-13)
LOCATION AND DESCRIPTION OF LABORATORY FACILITIES
SUBCONTRACTOR(S) UTILITZED BY FIRM FOR SOURCE TESTING ACTIVITIES
NUMBER OF AIR POLLUTION SOURCES PREVIOUSLY TESTED BY FIRM
SOURCES TESTED BY FIRM IN PAST THREE YEARS (SOURCE, TEST, DATE)
4. PERFORMANCE TEST INFORMATION
No. of
Total Time
No. of
Sampling
per
Test
Pollutant
Points
Test Run
Runs
Test Method to be Used
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
5. AUDIT INFORMATION
Sample matrix
Audit sample
Specific
Expected sample
and audit matrix
concentration
Method
analyte
concentration
(if different)
requested
Audit provider
780-2184 (01-13)
6. AUDIT PROVIDER INFORMATION
PROVIDER NUMBER ONE
ADDRESS
CITY
STATE
ZIP CODE
NAME OF CONTACT PERSON
TITLE
TELEPHONE NUMBER WITH AREA CODE
FAX NUMBER WITH AREA CODE
PROVIDER NUMBER TWO
ADDRESS
CITY
STATE
ZIP CODE
NAME OF CONTACT PERSON
TITLE
TELEPHONE NUMBER WITH AREA CODE
FAX NUMBER WITH AREA CODE
7. LABORATORY INFORMATION
NAME
ADDRESS
CITY
STATE
ZIP CODE
CONTACT PERSON
TITLE OF CONTACT PERSON
TELEPHONE NUMBER WITH AREA CODE FOR CONTACT PERSON
FAX NUMBER WITH AREA CODE FOR CONTACT PERSON
QUALITY CERTIFICATION
Certifying entity one:
Procedures/methods certified:
Certifying entity two:
Procedures/methods certified:
Certifying entity three:
Procedures/methods certified:
780-2184 (01-13)
7. SAMPLE LOCATION & TRAVERSE POINT INFORMATION
DUCT TO BE SAMPLED
Sketch of Stack or Duct with Port Locations & Distances Shown
[NOTE Cyclonic flow must be measured by instrument and
shown to be within allowable limits prior to initiation of
sampling.] If sampling location is downstream from an axial flow
fan, installation of a flow straightening device will probably be
DUCT DIMENSIONS
necessary to meet cyclonic flow criterion.
From inside far wall to outside of port
Nipple length
Depth (or diameter) of duct
Width (rectangular duct)
RECTANGULAR STACK EQUIVALENT DIAMETER
D
= 2 x Depth x Width = 2(
) (
) =
e
Depth + Width
(
+
)
DISTANCE FROM NEAREST FLOW DISTURBANCE TO PORTS
Upstream (A)
Downstream (B)
Distance
Diameters
Stack Area =
CALCULATED BY
TRAVERSE POINTS REFERENCE TABLES
LOCATION OF TRAVERSE POINTS IN RECTANGULAR STACKS
LOCATION OF TRAVERSE POINTS IN CIRCULAR STACKS
2
3
4
5
6
7
8
9
10
11
12
4
6
8
10
12
14
16
18
20
22
24
1
25
16.7
12.5
10
8.3
7.1
6.3
5.6
5
4.5
4.2
1
6.7
4.4
3.2
2.6
2.1
1.8
1.6
1.4
1.3
1.1
1.1
2
75
50
37.5
30
25
21.4
18.8
16.7
15
13.8
12.5
2
25
14.6
10.5
8.2
6.7
5.7
4.9
4.4
3.9
3.5
3.2
3
83.3
62.5
50
41.7
35.7
31.3
27.8
25
22.7
20.8
3
75
29.6
19.4
14.6
11.8
9.9
8.5
7.5
6.7
6
5.5
4
87.5
70
58.3
50
43.8
38.9
35
31.8
29.2
4
93.3
70.4
32.3
22.6
17.7
14.6
12.5
10.9
9.7
8.7
7.9
5
90
75
64.3
56.3
50
45
40.9
37.5
5
85.4
67.7
34.2
25
20.1
16.9
14.6
12.9
11.6
10.5
6
91.7
78.6
68.8
61.1
55
50
45.8
6
95.6
80.6
65.8
35.6
26.9
22
18.8
16.5
14.6
13.2
7
92.9
81.3
72.2
65
59.1
54.2
7
89.5
77.4
64.4
36.8
28.3
23.6
20.4
18
16.1
8
96.8
85.4
75
63.4
37.5
29.6
25
21.8
19.4
8
93.8
83.2
75
68.2
62.5
9
91.8
82.3
73.1
62.5
38.2
30.6
26.2
23
9
94.4
85
77.3
70.8
10
95
86.4
79.2
10
97.4
88.2
79.9
71.7
61.8
38.8
31.5
27.2
11
95.5
87.5
11
93.3
85.4
78
70.4
61.2
39.3
32.3
12
95.8
12
97.9
90.1
83.1
76.4
69.4
60.7
39.8
780-2184 (01-13)
7. SAMPLE LOCATION & TRAVERSE POINT INFORMATION (CONTINUED)
Distance from
Distance from
Point
Percent of Stack I.D.
Stack I.D.
Outside Wall
Nipple Length
Outside of Port
8. TEST PROCEDURES AND EQUIPMENT
A. SAMPLING EQUIPMENT INFORMATION
Include manufacturer and model of the sampling equipment to be used by the tester for the performance tests, along with a
description of any equipment which may differ from that required by the specified method(s).
B. TEST PROCEDURES
Describe test procedures to be used in the conduct of the performance tests which may differ from the specified method(s).
C. ANALYTICAL PROCEDURES
Describe analytical procedures which differ from the specified method(s).
D. DATA SHEETS
Include a sample of all field data sheets which do not provide the data shown on the example sheets in 40 CFR 60 for the specified
method(s).
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