Form B "Application for Air Permit to Construct/Operate - Specific Emission Source Information (Required for All Sources)" - North Carolina

What Is Form B?

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

Form Details:

  • Released on September 22, 2016;
  • The latest edition provided by the North Carolina 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 B by clicking the link below or browse more documents and templates provided by the North Carolina Department of Environmental Quality.

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Download Form B "Application for Air Permit to Construct/Operate - Specific Emission Source Information (Required for All Sources)" - North Carolina

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FORM B
SPECIFIC EMISSION SOURCE INFORMATION (REQUIRED FOR ALL SOURCES)
B
REVISED 09/22/16
NCDEQ/Division of Air Quality - Application for Air Permit to Construct/Operate
EMISSION SOURCE DESCRIPTION:
EMISSION SOURCE ID NO:
CONTROL DEVICE ID NO(S):
OPERATING SCENARIO _________________ OF __________________
EMISSION POINT (STACK) ID NO(S):
DESCRIBE IN DETAILTHE EMISSION SOURCE PROCESS (ATTACH FLOW DIAGRAM):
TYPE OF EMISSION SOURCE (CHECK AND COMPLETE APPROPRIATE FORM B1-B9 ON THE FOLLOWING PAGES):
Coal,wood,oil, gas, other burner (Form B1)
Woodworking (Form B4)
Manuf. of chemicals/coatings/inks (Form B7)
Int.combustion engine/generator (Form B2)
Coating/finishing/printing (Form B5)
Incineration (Form B8)
Liquid storage tanks (Form B3)
Storage silos/bins (Form B6)
Other (Form B9)
START CONSTRUCTION DATE:
DATE MANUFACTURED:
MANUFACTURER / MODEL NO.:
EXPECTED OP. SCHEDULE: _____ HR/DAY _____ DAY/WK _____ WK/YR
IS THIS SOURCE SUBJECT TO?
NSPS (SUBPARTS?):__________________
NESHAP (SUBPARTS?):____________________________
PERCENTAGE ANNUAL THROUGHPUT (%): DEC-FEB
MAR-MAY
JUN-AUG
SEP-NOV
CRITERIA AIR POLLUTANT EMISSIONS INFORMATION FOR THIS SOURCE
SOURCE OF
EXPECTED ACTUAL
POTENTIAL EMISSIONS
EMISSION
(AFTER CONTROLS / LIMITS)
(BEFORE CONTROLS / LIMITS)
(AFTER CONTROLS / LIMITS)
AIR POLLUTANT EMITTED
FACTOR
lb/hr
tons/yr
lb/hr
tons/yr
lb/hr
tons/yr
PARTICULATE MATTER (PM)
PARTICULATE MATTER
<10 MICRONS (PM
)
10
PARTICULATE MATTER
<2.5 MICRONS (PM
)
2.5
SULFUR DIOXIDE (SO2)
NITROGEN OXIDES (NOx)
CARBON MONOXIDE (CO)
VOLATILE ORGANIC COMPOUNDS (VOC)
LEAD
OTHER
HAZARDOUS AIR POLLUTANT EMISSIONS INFORMATION FOR THIS SOURCE
SOURCE OF
EXPECTED ACTUAL
POTENTIAL EMISSIONS
EMISSION
(AFTER CONTROLS / LIMITS)
(BEFORE CONTROLS / LIMITS)
(AFTER CONTROLS / LIMITS)
HAZARDOUS AIR POLLUTANT
CAS NO.
FACTOR
lb/hr
tons/yr
lb/hr
tons/yr
lb/hr
tons/yr
TOXIC AIR POLLUTANT EMISSIONS INFORMATION FOR THIS SOURCE
SOURCE OF
EXPECTED ACTUAL EMISSIONS AFTER CONTROLS / LIMITATIONS
EMISSION
TOXIC AIR POLLUTANT
CAS NO.
FACTOR
lb/hr
lb/day
lb/yr
Attachments: (1) emissions calculations and supporting documentation; (2) indicate all requested state and federal enforceable permit limits (e.g. hours of operation, emission rates)
and describe how these are monitored and with what frequency; and (3) describe any monitoring devices, gauges, or test ports for this source.
COMPLETE THIS FORM AND COMPLETE AND ATTACH APPROPRIATE B1 THROUGH B9 FORM FOR EACH SOURCE
Attach Additional Sheets As Necessary
FORM B
SPECIFIC EMISSION SOURCE INFORMATION (REQUIRED FOR ALL SOURCES)
B
REVISED 09/22/16
NCDEQ/Division of Air Quality - Application for Air Permit to Construct/Operate
EMISSION SOURCE DESCRIPTION:
EMISSION SOURCE ID NO:
CONTROL DEVICE ID NO(S):
OPERATING SCENARIO _________________ OF __________________
EMISSION POINT (STACK) ID NO(S):
DESCRIBE IN DETAILTHE EMISSION SOURCE PROCESS (ATTACH FLOW DIAGRAM):
TYPE OF EMISSION SOURCE (CHECK AND COMPLETE APPROPRIATE FORM B1-B9 ON THE FOLLOWING PAGES):
Coal,wood,oil, gas, other burner (Form B1)
Woodworking (Form B4)
Manuf. of chemicals/coatings/inks (Form B7)
Int.combustion engine/generator (Form B2)
Coating/finishing/printing (Form B5)
Incineration (Form B8)
Liquid storage tanks (Form B3)
Storage silos/bins (Form B6)
Other (Form B9)
START CONSTRUCTION DATE:
DATE MANUFACTURED:
MANUFACTURER / MODEL NO.:
EXPECTED OP. SCHEDULE: _____ HR/DAY _____ DAY/WK _____ WK/YR
IS THIS SOURCE SUBJECT TO?
NSPS (SUBPARTS?):__________________
NESHAP (SUBPARTS?):____________________________
PERCENTAGE ANNUAL THROUGHPUT (%): DEC-FEB
MAR-MAY
JUN-AUG
SEP-NOV
CRITERIA AIR POLLUTANT EMISSIONS INFORMATION FOR THIS SOURCE
SOURCE OF
EXPECTED ACTUAL
POTENTIAL EMISSIONS
EMISSION
(AFTER CONTROLS / LIMITS)
(BEFORE CONTROLS / LIMITS)
(AFTER CONTROLS / LIMITS)
AIR POLLUTANT EMITTED
FACTOR
lb/hr
tons/yr
lb/hr
tons/yr
lb/hr
tons/yr
PARTICULATE MATTER (PM)
PARTICULATE MATTER
<10 MICRONS (PM
)
10
PARTICULATE MATTER
<2.5 MICRONS (PM
)
2.5
SULFUR DIOXIDE (SO2)
NITROGEN OXIDES (NOx)
CARBON MONOXIDE (CO)
VOLATILE ORGANIC COMPOUNDS (VOC)
LEAD
OTHER
HAZARDOUS AIR POLLUTANT EMISSIONS INFORMATION FOR THIS SOURCE
SOURCE OF
EXPECTED ACTUAL
POTENTIAL EMISSIONS
EMISSION
(AFTER CONTROLS / LIMITS)
(BEFORE CONTROLS / LIMITS)
(AFTER CONTROLS / LIMITS)
HAZARDOUS AIR POLLUTANT
CAS NO.
FACTOR
lb/hr
tons/yr
lb/hr
tons/yr
lb/hr
tons/yr
TOXIC AIR POLLUTANT EMISSIONS INFORMATION FOR THIS SOURCE
SOURCE OF
EXPECTED ACTUAL EMISSIONS AFTER CONTROLS / LIMITATIONS
EMISSION
TOXIC AIR POLLUTANT
CAS NO.
FACTOR
lb/hr
lb/day
lb/yr
Attachments: (1) emissions calculations and supporting documentation; (2) indicate all requested state and federal enforceable permit limits (e.g. hours of operation, emission rates)
and describe how these are monitored and with what frequency; and (3) describe any monitoring devices, gauges, or test ports for this source.
COMPLETE THIS FORM AND COMPLETE AND ATTACH APPROPRIATE B1 THROUGH B9 FORM FOR EACH SOURCE
Attach Additional Sheets As Necessary