"Non-applicability Statement for Boilers" - Massachusetts

Non-applicability Statement for 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 December 1, 2007;
  • The latest edition currently provided by the Massachusetts Department of Environmental Protection;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Massachusetts Department of Environmental Protection.

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Download "Non-applicability Statement for Boilers" - Massachusetts

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Massachusetts Department of Environmental Protection
Environmental Results Program
MassDEP Facility ID# (if known)
Non-Applicability Statement
For Boilers
Facility AQ # (if known)
A. Facility Information
Important:
When filling out
Facility Name
forms on the
computer, use
Facility Street Address
only the tab key
to move your
cursor - do not
City
State
Zip Code
use the return
key.
Phone Number
Fax Number
Contact Person Name
Title
Phone Number
B. Do You Need to Certify?
If any of the following conditions apply to your facility or boiler, then you are NOT required to submit an
ERP Compliance Certification for New Boilers.
Facility has an Operating Permit under 310 CMR 7.00 Appendix C.
Boiler is temporary, as defined in 310 CMR 7.03(23). Please provide the requested dates.
Installation Date:
Expected Removal Date:
Date (MM/DD/YYYY)
Date (MM/DD/YYYY)
All ERP boilers were removed or otherwise rendered inoperative as of:
Date (MM/DD/YYYY)
All ERP boilers were converted to wood fuel-fired boilers as of:
Date (MM/DD/YYYY)
Facility changed ownership as of:
Date (MM/DD/YYYY)
Save a copy of this statement for your records and mail the original form to:
MA DEP-ERP-CB
P.O. Box 120-165
Boston, MA 02112-0165
Note: Exemption from ERP does not relieve you of other environmental compliance requirements.
Signature
Date (MM/DD/YYYY)
blrnonap• Rev 12/07
Non-Applicability Statement for Boilers • Page 1 of 1
Massachusetts Department of Environmental Protection
Environmental Results Program
MassDEP Facility ID# (if known)
Non-Applicability Statement
For Boilers
Facility AQ # (if known)
A. Facility Information
Important:
When filling out
Facility Name
forms on the
computer, use
Facility Street Address
only the tab key
to move your
cursor - do not
City
State
Zip Code
use the return
key.
Phone Number
Fax Number
Contact Person Name
Title
Phone Number
B. Do You Need to Certify?
If any of the following conditions apply to your facility or boiler, then you are NOT required to submit an
ERP Compliance Certification for New Boilers.
Facility has an Operating Permit under 310 CMR 7.00 Appendix C.
Boiler is temporary, as defined in 310 CMR 7.03(23). Please provide the requested dates.
Installation Date:
Expected Removal Date:
Date (MM/DD/YYYY)
Date (MM/DD/YYYY)
All ERP boilers were removed or otherwise rendered inoperative as of:
Date (MM/DD/YYYY)
All ERP boilers were converted to wood fuel-fired boilers as of:
Date (MM/DD/YYYY)
Facility changed ownership as of:
Date (MM/DD/YYYY)
Save a copy of this statement for your records and mail the original form to:
MA DEP-ERP-CB
P.O. Box 120-165
Boston, MA 02112-0165
Note: Exemption from ERP does not relieve you of other environmental compliance requirements.
Signature
Date (MM/DD/YYYY)
blrnonap• Rev 12/07
Non-Applicability Statement for Boilers • Page 1 of 1