"Supplier Certification of Emission Performance New Engines and Turbines (Non-emergency) - Supplier Complete" - Massachusetts

Supplier Certification of Emission Performance New Engines and Turbines (Non-emergency) - Supplier Complete is a legal document that was released by the Massachusetts Department of Environmental Protection - a government authority operating within Massachusetts.

Form Details:

  • Released on January 1, 2018;
  • 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.

ADVERTISEMENT
ADVERTISEMENT

Download "Supplier Certification of Emission Performance New Engines and Turbines (Non-emergency) - Supplier Complete" - Massachusetts

249 times
Rate (4.6 / 5) 12 votes
Massachusetts Department of Environmental Protection
Facility Name
Environmental Results Program
Supplier Certification of Emission Performance
New Engines and Turbines (Non-Emergency) – Supplier Complete
MassDEP Facility ID#
(if known)
A. Facility Information
Important: When
filling out forms
Facility Name
on the computer,
use only the tab
Street Address
key to move your
cursor - do not
use the return
City
State
Zip Code
key.
Telephone Number
Fax Number
Contact Person Name
Contact Person Title
B. Supplier Information
Supplier Name
Street Address
City
State
Zip Code
Telephone Number
Fax Number
Contact Person Name
Contact Person Title
C. Compliance Information
Complete and submit an Initial Compliance Certification form for each new engine and turbine that is subject to the
Environmental Results Program (ERP) for Engines and Turbines. Answer all questions.
Model
Manufacturer of Unit
ID #
Serial #
Date Installed
Rated Power Output
(Kilowatts)
1.
Yes
No
Is the unit an engine?
2.
Yes
No
Is the unit a turbine?
Yes
No
3.
Is the primary fuel to be burned natural gas?
4.
Yes
No
Is the primary fuel to be burned fuel oil?
Non-Emergency Supplier Cert 2018
Supplier Certification of Performance: New Engines & Turbines • Page 1 of 2
Massachusetts Department of Environmental Protection
Facility Name
Environmental Results Program
Supplier Certification of Emission Performance
New Engines and Turbines (Non-Emergency) – Supplier Complete
MassDEP Facility ID#
(if known)
A. Facility Information
Important: When
filling out forms
Facility Name
on the computer,
use only the tab
Street Address
key to move your
cursor - do not
use the return
City
State
Zip Code
key.
Telephone Number
Fax Number
Contact Person Name
Contact Person Title
B. Supplier Information
Supplier Name
Street Address
City
State
Zip Code
Telephone Number
Fax Number
Contact Person Name
Contact Person Title
C. Compliance Information
Complete and submit an Initial Compliance Certification form for each new engine and turbine that is subject to the
Environmental Results Program (ERP) for Engines and Turbines. Answer all questions.
Model
Manufacturer of Unit
ID #
Serial #
Date Installed
Rated Power Output
(Kilowatts)
1.
Yes
No
Is the unit an engine?
2.
Yes
No
Is the unit a turbine?
Yes
No
3.
Is the primary fuel to be burned natural gas?
4.
Yes
No
Is the primary fuel to be burned fuel oil?
Non-Emergency Supplier Cert 2018
Supplier Certification of Performance: New Engines & Turbines • Page 1 of 2
Massachusetts Department of Environmental Protection
Facility Name
Environmental Results Program
Supplier Certification of Emission Performance
New Engines and Turbines (Non-Emergency) – Supplier Complete
MassDEP Facility ID#
(if known)
B. Compliance Information
(continued)
5.
Please list the applicable emission limitations that you are certifying that the unit complies with for the lesser of
15,000 hours of operation or the first three years of operation.
See 310 CMR 7.26(43) Tables 1,2 and 3, or Workbook Section 2.1
Oxides of Nitrogen
Particulate Matter
Pounds Per Megawatt Hour
Pounds Per Megawatt Hour
Carbon Monoxide
Ammonia
Pounds Per Megawatt Hour
Parts Per Million
Carbon Dioxide
Pounds Per Megawatt Hour
D. Supplier Certification Statement
I attest under the pains and penalties of perjury:
Signature
I.
That I have personally examined and am
Print First Name
familiar with the information contained in this
submittal, including any and all documents
Print Last Name
accompanying this certification statement;
II. That, based on my inquiry of those individuals
Title
responsible for obtaining the information, the
information contained in this submittal is, to
Date of Certification (MM/DD/YYYY)
the best of my knowledge, true, accurate, and
complete;
Source of Signatory Authority:
III. That the engine is capable of meeting the
emission limitations established in 310 CMR
If a Corporation:
7.26(43): Tables 2, 3 and 4 for the lesser of
15,000 hours of operation or the first three
President
years of operation; and
IV. That I am fully authorized to make this
Secretary
attestation on behalf of this engine
manufacturer.
Treasurer
Vice President
I am aware that there are significant penalties,
(if authorized by corporate vote)
including, but not limited to, possible fines and
Representative of the above
imprisonment, for willfully submitting false,
(if authorized by
corporate vote and if responsible for overall operation of
inaccurate, or incomplete information.
the facility)
If a Partnership:
General Partner
If a Sole Proprietorship:
Proprietor
Non-Emergency Supplier Cert 2018
Supplier Certification of Performance: New Engines & Turbines • Page 2 of 2
Page of 2