Form SFN8536 "Fuel Burning Equipment Used for Indirect Heating Annual Emission Inventory Report" - North Dakota

What Is Form SFN8536?

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 February 1, 2015;
  • 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 SFN8536 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 SFN8536 "Fuel Burning Equipment Used for Indirect Heating Annual Emission Inventory Report" - North Dakota

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FUEL BURNING EQUIPMENT USED FOR INDIRECT HEATING
ANNUAL EMISSION INVENTORY REPORT
NORTH DAKOTA DEPARTMENT OF HEALTH
DIVISION OF AIR QUALITY
SFN 8536 (02-15)
GENERAL
Name of Firm or Organization
Permit to Operate Number
Year of Emissions
Mailing Address
City
State
ZIP Code
Facility Name
Facility Location
Emission Unit Number
EQUIPMENT INFORMATION
Manufacturer of Unit
Model Number
Max Heat Input (Btu/hr)
Gross Electricity Generated
(MWh)*
Boiler Type: ☐ Pulverized Tangential
☐ Pulverized Wall Fired
☐ Fluidized Bed
Hours of Operation
Net Electricity Generated
(MWh)*
☐ Cyclone ☐ Stoker Type: ___________________ ☐ Other: Specify: ____________
*Electric utility only.
FUELS USED
Primary Fuel
Standby Fuel
Other Fuel
Type
(ex. Lignite coal, Subbituminous coal, RDF,
Natural gas, LPG, No. 2 oil, No. 6 oil. etc.)
Quantity of Fuel per Year
(Specify Units: ex. ton, gal, cu.ft., etc.)
Percent Ash (Coal Only)
Average
Percent Sulfur
Average
Btu per Unit (Specify lb, ton, gal, etc.)
Average
Percent Sodium in Coal Ash
Average
(The table below is used for single fuel combustion. Use the tables on the other side if multiple fuels are combusted
TOTAL STACK EMISSIONS
and then summarize the total emissions per year in the “Tons” column below.)
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
Mercury***
Ammonia***
**Submit SFN 19839 for Hazardous Air Pollutants if applicable.
***Title V coal and oil-fired units only.
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
FUEL BURNING EQUIPMENT USED FOR INDIRECT HEATING
ANNUAL EMISSION INVENTORY REPORT
NORTH DAKOTA DEPARTMENT OF HEALTH
DIVISION OF AIR QUALITY
SFN 8536 (02-15)
GENERAL
Name of Firm or Organization
Permit to Operate Number
Year of Emissions
Mailing Address
City
State
ZIP Code
Facility Name
Facility Location
Emission Unit Number
EQUIPMENT INFORMATION
Manufacturer of Unit
Model Number
Max Heat Input (Btu/hr)
Gross Electricity Generated
(MWh)*
Boiler Type: ☐ Pulverized Tangential
☐ Pulverized Wall Fired
☐ Fluidized Bed
Hours of Operation
Net Electricity Generated
(MWh)*
☐ Cyclone ☐ Stoker Type: ___________________ ☐ Other: Specify: ____________
*Electric utility only.
FUELS USED
Primary Fuel
Standby Fuel
Other Fuel
Type
(ex. Lignite coal, Subbituminous coal, RDF,
Natural gas, LPG, No. 2 oil, No. 6 oil. etc.)
Quantity of Fuel per Year
(Specify Units: ex. ton, gal, cu.ft., etc.)
Percent Ash (Coal Only)
Average
Percent Sulfur
Average
Btu per Unit (Specify lb, ton, gal, etc.)
Average
Percent Sodium in Coal Ash
Average
(The table below is used for single fuel combustion. Use the tables on the other side if multiple fuels are combusted
TOTAL STACK EMISSIONS
and then summarize the total emissions per year in the “Tons” column below.)
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
Mercury***
Ammonia***
**Submit SFN 19839 for Hazardous Air Pollutants if applicable.
***Title V coal and oil-fired units only.
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
SFN 8536 (02-15) Page 2
Primary Fuel (Type):
Quantity:
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
Mercury***
Ammonia***
STACK EMISSIONS
Standby Fuel (Type):
Quantity:
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
Mercury***
Ammonia***
STACK EMISSIONS
Other Fuel (Type):
Quantity:
Air Contaminant **
Emission Factor
Emission Factor Source
Tons
(Include Units)
(Include Test Date if Applicable)
Particulate – Total (Filterable)
Particulate – PM
(Filterable)
10
Particulate – PM
(Filterable)
2.5
Particulate – CPM Condensable)
Sulfur Dioxide
Nitrogen Oxides
Carbon Monoxide
Total Organic Compounds:
Nonmethane
Other
**Submit SFN 19839 for Hazardous Air Pollutants if applicable.
***Title V coal and oil-fired units only.
Use additional sheets if necessary to provide calculations for quantities listed above.
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