Form SFN8537 "Manufacturing or Processing Equipment Annual Emission Inventory Report" - North Dakota

What Is Form SFN8537?

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

Form Details:

  • Released on June 1, 2014;
  • The latest edition provided by the North Dakota Department of Health;
  • 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 SFN8537 by clicking the link below or browse more documents and templates provided by the North Dakota Department of Health.

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Download Form SFN8537 "Manufacturing or Processing Equipment Annual Emission Inventory Report" - North Dakota

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MANUFACTURING OR PROCESSING EQUIPMENT
ANNUAL EMISSION INVENTORY REPORT
NORTH DAKOTA DEPARTMENT OF HEALTH
DIVISION OF AIR QUALITY
SFN 8537 (06-14)
GENERAL
Name of Firm or Organization
Permit to Operate Number
Year of Emissions
Mailing Address
City
State
ZIP Code
Facility Name
Facility Location
Actual Hours of Operation
Source Unit Description
Emission Unit Number
RAW MATERIAL INFORMATION
Raw Materials Introduced into Process
Quantity
(Specify Units)
FUELS USED
Primary Fuel
Auxiliary Fuel
Type
(ex. lignite, natural gas, LPG
No. 2 fuel oil, No. 6 fuel oil. etc.)
Quantity of Fuel per Year
(Specify Units: ex. ton, gal, cu.ft., etc.)
Percent Sulfur
Maximum
Average
Btu per Unit
(Specify Unit in lb, ton, gal, etc.)
Average
STACK EMISSIONS
Air Contaminant *
Emission Factor
Emission Factor Source
Tons
(Include Units)
(Include Test Date if Applicable)
Particulate – Total PM (Filterable)
Particulate - PM
(Filterable)
10
Particulate - PM
(Filterable)
2.5
Particulate – CPM (Condensable)
Sulfur Dioxide
Nitrogen Oxides
Carbon Monoxide
Total Organic Compounds: Nonmethane
* Submit SFN 19839 for Hazardous Air Pollutants if applicable.
I declare under the penalties of perjury that this report has been examined by me and to the best of my knowledge is a true, correct and complete report.
Print Name of Person Submitting Report
Title
Telephone Number
Signature
Email Address
Date
Return completed form to:
North Dakota Department of Health
Division of Air Quality
918 E Divide, 2nd Floor
Bismarck, ND 58501-1947
Telephone:(701)328-5188
MANUFACTURING OR PROCESSING EQUIPMENT
ANNUAL EMISSION INVENTORY REPORT
NORTH DAKOTA DEPARTMENT OF HEALTH
DIVISION OF AIR QUALITY
SFN 8537 (06-14)
GENERAL
Name of Firm or Organization
Permit to Operate Number
Year of Emissions
Mailing Address
City
State
ZIP Code
Facility Name
Facility Location
Actual Hours of Operation
Source Unit Description
Emission Unit Number
RAW MATERIAL INFORMATION
Raw Materials Introduced into Process
Quantity
(Specify Units)
FUELS USED
Primary Fuel
Auxiliary Fuel
Type
(ex. lignite, natural gas, LPG
No. 2 fuel oil, No. 6 fuel oil. etc.)
Quantity of Fuel per Year
(Specify Units: ex. ton, gal, cu.ft., etc.)
Percent Sulfur
Maximum
Average
Btu per Unit
(Specify Unit in lb, ton, gal, etc.)
Average
STACK EMISSIONS
Air Contaminant *
Emission Factor
Emission Factor Source
Tons
(Include Units)
(Include Test Date if Applicable)
Particulate – Total PM (Filterable)
Particulate - PM
(Filterable)
10
Particulate - PM
(Filterable)
2.5
Particulate – CPM (Condensable)
Sulfur Dioxide
Nitrogen Oxides
Carbon Monoxide
Total Organic Compounds: Nonmethane
* Submit SFN 19839 for Hazardous Air Pollutants if applicable.
I declare under the penalties of perjury that this report has been examined by me and to the best of my knowledge is a true, correct and complete report.
Print Name of Person Submitting Report
Title
Telephone Number
Signature
Email Address
Date
Return completed form to:
North Dakota Department of Health
Division of Air Quality
918 E Divide, 2nd Floor
Bismarck, ND 58501-1947
Telephone:(701)328-5188