5900 Fee Filing Form

OMB No. 2060-0336, Approval Expires 06/30/2010

Federal Operating Permit Program (40 CFR Part 71)

FEE FILING FORM (FF)

Complete this form each time you prepare form FEE and send this form to the appropriate lockbox bank address, along with full payment. This form required at time of initial fee payment, and thereafter, when paying annual fees.

Source or Facility Name__________________________________________________________

Mailing Address:

Street/P.O. Box ______________________________ City_____________________________

State ______ ZIP __________ - ______

Contact Person:_____________________________ Title______________________________

Telephone ( ____ ) _____ - __________ Ext. __________

Total Fee Payment Remitted: $ __________________._____

INSTRUCTIONS FOR FF

FEE FILING FORM

Send this form along with fee payment to the appropriate Alockbox@ bank account address.

Lockbox Bank Account Addresses for each EPA Region

REGION I U.S. EPA - Region I P.O. Box 360197M Pittsburgh, PA 15251	REGION VI U.S. EPA - Region VI P.O. Box 360582M Pittsburgh, PA 15251
REGION II U.S. EPA - Region II P.O. Box 360188M Pittsburgh, PA 15251	REGION VII Mellon Bank U.S. EPA - Region VII Box 360748M Pittsburgh, PA 15251-6748
REGION III U.S. EPA - Region III P.O. Box 360515 Pittsburgh, PA 15251-6515	REGION VIII Mellon Bank Attn: Part 71 Permit Accounting Lockbox 360859 Pittsburgh, PA 15251‑6859
REGION IV U.S. EPA - Region IV Nationsbank P.O. Box 100142 Atlanta, GA 30384	REGION IX Mellon Bank U.S. EPA - Region IX P.O. Box 360863M Pittsburgh, PA 15251
REGION V U.S. EPA - Region V P.O. Box 70753 Chicago, IL 60673	REGION X U.S. EPA - Region X P.O. Box 360903M Pittsburgh, PA 15251

Fee payments must be in United States currency and shall be paid by money order, bank draft, certified check, corporate check, or electronic funds transfer payable to the order of the U.S. Environmental Protection Agency.

Important: Please also send a photocopy of the fee payment instrument (e.g., the check) to the EPA regional office (or delegate agency).

EPA Form 5900-06