"Installation Compliance Certification for New Emergency Engines and Emergency Turbines" - Massachusetts

Installation Compliance Certification for New Emergency Engines and Emergency Turbines 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 "Installation Compliance Certification for New Emergency Engines and Emergency Turbines" - Massachusetts

Download PDF

Fill PDF online

Rate (4.4 / 5) 13 votes
Massachusetts Department of Environmental Protection
Environmental Results Program
Facility Name
Installation Compliance Certification
For New Emergency Engines and Emergency Turbines
MassDEP Facility ID# (if known)
A. Facility Information
Important: When
1. Facility Location:
filling out forms
on the computer,
use only the tab
key to move your
Facility Name
cursor - do not
use the return
Street Address
key.
City
State
Zip Code
Federal Employer ID # (FEIN)
2. Mailing Address and Contact Information:
Street/PO Box:
Email Address
City
State
Zip Code
Telephone Number
Fax Number
Contact Person Name
Contact Person Title
B. Compliance Information
Complete and submit an Initial Compliance Certification form for each new emergency engine and emergency turbine
that is subject to the Environmental Results Program (ERP) for Emergency Engines and Emergency Turbines.
Answer all questions. IMPORTANT NOTE: Answering “No” to certain questions requires completion of the Return to
Compliance form. In these cases, the notation “RTC” appears next to “No.”
Engine or Turbine
Genset
Manufacturer of Unit
Model #
Serial #
N/A
Rated Power Output (Engine or Turbine)
N/A
Electrical Output (Kilowatts)
Date Installed (MM/DD/YYYY)
EPA Certificate # for Unit (Oil-Fired Engines Only)
Date Operation Commenced (MM/DD/YYYY)
Installation Compliance Certification: New Emergency Engines and Turbines • Page 1 of
Emergency Engine Cert 2018
4
Massachusetts Department of Environmental Protection
Environmental Results Program
Facility Name
Installation Compliance Certification
For New Emergency Engines and Emergency Turbines
MassDEP Facility ID# (if known)
A. Facility Information
Important: When
1. Facility Location:
filling out forms
on the computer,
use only the tab
key to move your
Facility Name
cursor - do not
use the return
Street Address
key.
City
State
Zip Code
Federal Employer ID # (FEIN)
2. Mailing Address and Contact Information:
Street/PO Box:
Email Address
City
State
Zip Code
Telephone Number
Fax Number
Contact Person Name
Contact Person Title
B. Compliance Information
Complete and submit an Initial Compliance Certification form for each new emergency engine and emergency turbine
that is subject to the Environmental Results Program (ERP) for Emergency Engines and Emergency Turbines.
Answer all questions. IMPORTANT NOTE: Answering “No” to certain questions requires completion of the Return to
Compliance form. In these cases, the notation “RTC” appears next to “No.”
Engine or Turbine
Genset
Manufacturer of Unit
Model #
Serial #
N/A
Rated Power Output (Engine or Turbine)
N/A
Electrical Output (Kilowatts)
Date Installed (MM/DD/YYYY)
EPA Certificate # for Unit (Oil-Fired Engines Only)
Date Operation Commenced (MM/DD/YYYY)
Installation Compliance Certification: New Emergency Engines and Turbines • Page 1 of
Emergency Engine Cert 2018
4
Massachusetts Department of Environmental Protection
Environmental Results Program
Facility Name
Installation Compliance Certification
For New Emergency Engines and Emergency Turbines
MassDEP Facility ID# (if known)
B. Compliance Information
(continued)
Yes – Go to
No
1.
Is the new unit an emergency engine?
Question 3
2.
Yes
No
Is the new unit an emergency turbine?
3.
Yes
No
Is the primary fuel to be burned natural gas?
4a.
Yes
No
Is the primary fuel to be burned fuel oil?
4b.
Are you only accepting delivery of fuel that
Yes
No
meets the sulfur content limits pursuant to 310
CMR 7.05 (i.e., less than 15 ppm sulfur)?
Workbook Section 2.2.
No – RTC
Yes
5a.
For emergency engines burning fuel oil, have
you attached to this certification a statement
from the supplier that the engine has been
issued, by the Administrator of the U.S.
Environmental Protection Agency (EPA), a
certificate of conformity stating that it meets the
applicable emission standards?
Workbook Section 2.1.
No – RTC
5b.
For emergency engines burning natural gas,
Yes
have you attached a letter or other
documentation from your supplier that the
engine meets the applicable non-road emission
limitations that will satisfy the certificate of
conformity requirement at the time of installation
and is capable of compliance with the emission
limitations for the first three years of operation?
Workbook Section 2.1.
No – RTC
6.
Is the unit equipped with a non-turn back hour
Yes
counter?
Workbook Section 2.3.
No – RTC
7.
Will the emergency engine only operate during
Yes
emergencies, and for up to 100 hours/year for
maintenance checks and readiness testing (or as
otherwise approved by EPA) includingup to 50
hours/year for non-emergency use, as allowed by
40 CFR 63 part ZZZZ?
No – RTC
Is the exhaust stack configured to discharge
Yes
8a.
combustion gases vertically, and not equipped
with any part or device that restricts the vertical
exhaust flow of the emitted combustion gases?
Workbook Section 2.4.
Installation Compliance Certification: New Emergency Engines and Turbines • Page 2 of
Emergency Engine Cert 2018
4
Massachusetts Department of Environmental Protection
Environmental Results Program
Facility Name
Installation Compliance Certification
For New Emergency Engines and Emergency Turbines
MassDEP Facility ID# (if known)
B. Compliance Information
(continued)
No – RTC
Have you located the unit to minimize emission
Yes
8b.
impacts on sensitive receptors, including but not
limited to, people, windows and doors that
open, and building fresh air intakes, by
employing good air pollution control engineering
practices? Such practices include avoiding
locations that may be subject to downwash of
the exhaust and providing sufficient stack height
to minimize flue gas impacts upon sensitive
receptors.
Workbook Section 2.4
For questions 8c and 8d, answer only the questions that apply to your unit’s power output rating.
If your unit is rated at less than 300 kilowatts, skip to Question 12.
Yes –If Unit is
No – RTC
8c.
If the unit has a power output rating of 300
kilowatts or greater, is the height of the stack a
Below 1 Megawatt
minimum of ten feet above the facility rooftop or
Go to Question 11;
unit enclosure, whichever is lower?
otherwise Go to
Workbook Section 2.4
Question 8d
Yes – Go to
No – Go to Question 9
If the unit has a power output rating of one
8d.
megawatt or greater, is the height of the stack
Question 11
at least ten feet above and greater than 1.5
times above the height of the building, and
higher than the height of any structure that is
within 5L of the stack (5L being five times the
lesser of the height or maximum projected width
of the structure)?
Workbook Section 2.4
No – RTC
If you answered No to Question 8d, have you
9.
performed an analysis using an EPA dispersion
Yes
model to determine that emissions will not
cause a violation of the National Ambient Air
Quality Standards?
Workbook Section 2.4.
See Appendix 1 for data needs
No – RTC
10.
Did the analysis demonstrate that the stack
Yes
emissions will not cause a violation of the
National Ambient Air Quality Standards?
(Attach a copy of the analysis to this
certification form)
No – RTC
11.
Is the unit designed, and have you located the
Yes
unit, so that when operated sound impacts upon
sensitive receptors will be minimized and will be
in compliance with 310 CMR 7.10 Noise?
Workbook Section 2.5.
Installation Compliance Certification: New Emergency Engines and Turbines • Page 3 of
Emergency Engine Cert 2018
4
Massachusetts Department of Environmental Protection
Environmental Results Program
Facility Name
Installation Compliance Certification
For New Emergency Engines and Emergency Turbines
MassDEP Facility ID# (if known)
No – RTC
Have you put in place procedures to maintain
Yes
12.
records as listed in Section 2.6 of the
workbook?
C. Certification Statement
Note: Complete all required forms before signing this statement
I attest under the pains and penalties of perjury:
Signature
I.
That I have personally examined and am familiar with
Print First Name
the information contained in this submittal, including
any and all documents accompanying this certification
statement;
Print Last Name
II.
That, based on my inquiry of those individuals
responsible for obtaining the information, the
Title
information contained in this submittal is, to the best
of my knowledge, true, accurate, and complete;
Date of Certification (MM/DD/YYYY)
III. That systems to maintain compliance are in place at
the facility and will be maintained even if processes or
Source of Signatory Authority:
operating procedures are changed; and
IV. That I am fully authorized to make this attestation on
If a Corporation:
behalf of this facility.
President
Secretary
I am aware that there are significant penalties, including,
Treasurer
Vice President*
but not limited to, possible fines and imprisonment, for
willfully submitting false, inaccurate, or incomplete
Representative of the above**
information.
* If authorized by corporate
**If authorized by corporate vote and responsible for overall
operation of the facility
If a Partnership:
General Partner
If a Sole Proprietorship:
Proprietor
If a Municipality or Public Agency:
Principal Executive Officer
Ranking Elected Official (empowered to enter into
contracts on behalf of the municipality or public agency)
Installation Compliance Certification: New Emergency Engines and Turbines • Page 4 of
Emergency Engine Cert 2018
4