Form ECY070-502 "Washington Greenhouse Gas Reporting Program: Facility Report Signature and Submittal Form" - Washington

What Is Form ECY070-502?

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

Form Details:

  • Released on March 1, 2015;
  • The latest edition provided by the Washington State Department of Ecology;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of Form ECY070-502 by clicking the link below or browse more documents and templates provided by the Washington State Department of Ecology.

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Download Form ECY070-502 "Washington Greenhouse Gas Reporting Program: Facility Report Signature and Submittal Form" - Washington

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GHG Reporting Program: Facility Report Signature and Submittal Form
Washington Greenhouse Gas Reporting Program:
FRSS
Facility Report Signature and Submittal Form
Washington State Department of Ecology
Greenhouse Gas Reporting Program
For Ecology Use Only
Date
Air Quality Program
Received:
P.O. Box 47600
Form
Reviewed
Entered
Verified
Olympia, WA 98504-7600
Site ID
ghgreporting@ecy.wa.gov
(360)-407-6811
Web site:
http://www.ecy.wa.gov/programs/air/permit_register/ghg/ghg.html
See the second page of this form for instructions.
1. Report Information – Enter the information below
EPA GHGRP Id
XML Report Submittal ID
Reporting Year
2. Facility Information – Enter the information below
Name
Physical Address
City/State/Zip
3. Signer Information – Enter the information below
Name
Organization
Mailing Address
City/State/Zip
Phone Number (Ext)
Email Address
4. Petition to Use Updated EPA Calculation Methods
I petition Ecology under WAC 173-441-140 to use the updated EPA calculation methods from all relevant
Subparts C-UU of 40 C.F.R. Part 98 as adopted by the signature date below to generate and submit my
GHG report for this reporting year. I understand that updated calculation methods are necessary in order
to comply with RCW 70.94.151(5)(c) and to use EPA’s Electronic Greenhouse Gas Reporting Tool. I also
understand that nothing in this petition alters the deadlines, applicability, or other general requirements
established under WAC 173-441 and RCW 70.94.151.
5 .Certification Statement
I am authorized to make this submission on behalf of the owners and operators of the facility listed above,
for which the submission is made. I certify under penalty of law that I have personally examined, and am
familiar with, the statements and information submitted in this document, electronic submissions, and all
its attachments. Based on my inquiry of those individuals with primary responsibility for obtaining the
information, I certify that the statements and information are to the best of my knowledge and belief true,
accurate, and complete. I am aware that there are significant penalties for submitting false statements
and information or omitting required statements and information, including the possibility of fine or
imprisonment.
6. Signature (sign and date on the lines below)
Signature
Date
To request ADA accommodation, call 360-407-6800, 711 (relay service), or 877-833-6341 (TTY).
ECY 070-502 (rev. 3/15)
Page 1
GHG Reporting Program: Facility Report Signature and Submittal Form
Washington Greenhouse Gas Reporting Program:
FRSS
Facility Report Signature and Submittal Form
Washington State Department of Ecology
Greenhouse Gas Reporting Program
For Ecology Use Only
Date
Air Quality Program
Received:
P.O. Box 47600
Form
Reviewed
Entered
Verified
Olympia, WA 98504-7600
Site ID
ghgreporting@ecy.wa.gov
(360)-407-6811
Web site:
http://www.ecy.wa.gov/programs/air/permit_register/ghg/ghg.html
See the second page of this form for instructions.
1. Report Information – Enter the information below
EPA GHGRP Id
XML Report Submittal ID
Reporting Year
2. Facility Information – Enter the information below
Name
Physical Address
City/State/Zip
3. Signer Information – Enter the information below
Name
Organization
Mailing Address
City/State/Zip
Phone Number (Ext)
Email Address
4. Petition to Use Updated EPA Calculation Methods
I petition Ecology under WAC 173-441-140 to use the updated EPA calculation methods from all relevant
Subparts C-UU of 40 C.F.R. Part 98 as adopted by the signature date below to generate and submit my
GHG report for this reporting year. I understand that updated calculation methods are necessary in order
to comply with RCW 70.94.151(5)(c) and to use EPA’s Electronic Greenhouse Gas Reporting Tool. I also
understand that nothing in this petition alters the deadlines, applicability, or other general requirements
established under WAC 173-441 and RCW 70.94.151.
5 .Certification Statement
I am authorized to make this submission on behalf of the owners and operators of the facility listed above,
for which the submission is made. I certify under penalty of law that I have personally examined, and am
familiar with, the statements and information submitted in this document, electronic submissions, and all
its attachments. Based on my inquiry of those individuals with primary responsibility for obtaining the
information, I certify that the statements and information are to the best of my knowledge and belief true,
accurate, and complete. I am aware that there are significant penalties for submitting false statements
and information or omitting required statements and information, including the possibility of fine or
imprisonment.
6. Signature (sign and date on the lines below)
Signature
Date
To request ADA accommodation, call 360-407-6800, 711 (relay service), or 877-833-6341 (TTY).
ECY 070-502 (rev. 3/15)
Page 1
GHG Reporting Program: Facility Report Signature and Submittal Form
Instructions
Complete this form by typing, then printing; or by printing, then writing legibly in blue or black ink.
Then mail it to the following address by the reporting deadline for your facility. Attach additional sheets
if more space is needed.
Washington State Department of Ecology
Greenhouse Gas Reporting Program
Air Quality Program
P.O. Box 47600
Olympia, WA 98504-7600
Facilities required to report GHG emissions to both Ecology and EPA must submit their reports by
March 31 of the following year. Facilities that report only to Ecology must submit their reports by
October 31 of the following year.
Contact Ecology at
ghgreporting@ecy.wa.gov
or (360)-407-6811 if you have questions.
1. Report Information
EPA GHGRP Id
Facility ID number assigned by EPA’s e-GGRT.
It is visible in e-GGRT and in your xml file.
XML Report Submittal ID
This number is displayed in Ecology’s eGGR tool after uploading an xml
file. After upload, the number is in green on the page. The number starts
with the prefix “GHG.”
Reporting Year
The calendar year in which the emissions occurred.
2. Facility Information
Name
Facility name.
Physical Address
Facility physical address.
City/State/Zip
3. Signer Information
Name
Individual signing this form. This person must have also submitted a
Certificate of Representation
for this facility.
Organization
Signer’s employer.
Mailing Address
Signer’s address.
It will be used for correspondence and billing.
City/State/Zip
Phone Number (Ext.)
Signer’s phone number. Optionally, you can also list fax number.
Email Address
Signer’s email address.
4. Petition to Use Updated EPA Calculation Methods
Petition
Read the petition to use updated EPA calculation methods.
5 .Certification Statement
Certification Statement
Read the certification statement.
6. Signature
Signature
Sign the form.
Date
Date form was signed.
ECY 070-502 (rev. 3/15)
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