7630-6 Report Of Closure

Form Approved OMB 2060-0558 Approval Expires 11/30/2007

U NITED STATES ENVIRONMENTAL PROTECTION AGENCY

REGION 10 FEDERAL AIR RULES FOR INDIAN RESERVATIONS

REPORT OF CLOSURE

Applicability: Air pollution sources regulated by 40 Code of Federal Regulations Part 49.138.

INSTRUCTIONS: Except for regular seasonal closures, after initial registration, the owner or operator of an air pollution source must submit a report of closure in writing within 90 days after cessation of all operations.

INSTRUCTIONS: Complete applicable parts of Sections A, B, and C.

A. GENERAL INFORMATION

Identifying Information

Source (Facility) Name___________________________________________________

Effective Date of the Source Closure ____/____/________

Air Quality Operating Permit No. (if applicable)_____________________________________

Nature of the Business_________________________________________________________

Telephone (_____) _______-________ Facsimile (_____)______-________

Source Physical Address: Street ________________________________________

City______________________ County_______________ State ________ ZIP _________-________

Indian Reservation Name______________________________________________

Compliance Contact ______________________________ Title__________________________

(Local Person responsible for source compliance with this rule)

Telephone (_____) _______-________ Ext. _________ Facsimile (_____)______-________

Contact Person Mailing Address: Street (or PO Box #) __________________________________

City___________________ County__________________ State ________ ZIP _________-________

e.mail address _____________________________

A. GENERAL INFORMATION Cont.

Owner’s Name___________________________________________________

Telephone (_____) _______-________ Ext. _________ Facsimile (_____)______-________

Owner’s Mailing Address: Street ( or PO Box #) _______________________________

City______________________ County________________ State ________ ZIP _________-________

e.mail address ______________________________

Contact ____________________Title__________________________

(Person authorized to receive requests for data and information)

Telephone (_____) _______-________ Ext. _________ Facsimile (_____)______-________

Contact Mailing Address: Street (or PO Box #) ________________________________________

City____________________ County_____________________ State ________ ZIP _________-________

e.mail address _______________________________

Operator’s Name____________________________________(If different from owner)

Telephone (_____) _______-________ Ext. _________ Facsimile (_____)______-________

Operator’s Mailing Address: Street ( or PO Box #) _______________________________

City______________________ County________________ State ________ ZIP _________-________

e.mail address ______________________________

Contact ____________________Title__________________________

(Person authorized to receive requests for data and information)

Telephone (_____) _______-________ Ext. _________ Facsimile (_____)______-________

Contact Mailing Address: Street (or PO Box #) ________________________________________

City____________________ County_____________________ State ________ ZIP _________-________

e.mail address _______________________________

B. REPORT OF CLOSURE

Provide: A written description of closure activities and/or care and maintenance activities performed at the source and a statement describing the duration of the source closure. (e.g. temporary vs. permanent).

Confidential Treatment of Information

You may assert a business confidentiality claim covering any portion of the submitted information as provided in 40 C.F.R. part 2, subpart B. Please submit any information you claim as confidential business information separately, along with your claim of confidentiality. Note that emissions data and information necessary to determine emissions is not entitled to confidential treatment. Failure to assert a claim in the manner described in 40 C.F.R. part 2, subpart B allows the submitted information to be released to the public without further notice. Information subject to a business confidentiality claim may be disclosed by EPA only to the extent set forth in the above-cited regulations.

C. OWNER OR OPERATOR CERTIFICATION OF TRUTH, ACCURACY AND COMPLETENESS

Certifying Official Information: Identify the certifying official and provide contact information.

Name: (Last)____________________(First)__________________(Middle)_____________

Title______________________________________________________________________

Street or P.O. Box______________________________________________________

City_________________County________________State______________ZIP________-__________

Telephone (____)_____-__________ Ext._______ Facsimile (____)________-___________

e.mail address __________________________________________

Certification of Truth, Accuracy and Completeness: The Certifying Official must sign this statement after the form is completed.

I certify that, based on information and belief formed after reasonable inquiry, the statements and information contained in these documents are true, accurate and complete.

Name (signed)________________________________________________________

Name (printed or typed)_______________________________________Date____/____/_______

Return completed forms and attachments to:

EPA Region 10 (OAWT)

FARR Registration Coordinator

Office of Air Waste and Toxics

1200 Sixth Avenue

Seattle, WA 98101

The public reporting and recordkeeping burden for this collection of information is estimated at eight hours for a facility which is not considered a complex operation, and up to 40 hours for a moderately complex operation. Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including through the use of automated collection techniques to the Director, Collection Strategies Division, US Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number 2060-0558 in any correspondence. Do not send the completed form to this address.

FARR REGISTRATION APPLICATION INSTRUCTIONS

GENERAL INFORMATION

Identifying Information

FACILITY

Enter the name and the correct street addressor other physical location of the facility (e.g. Acme Road or Building 3, XYZ Industrial Park) together with telephone and facsimile numbers.

Provide a brief description of the nature of the business conducted by the facility.

Provide name of the Indian Reservation on which the facility is located.

Provide name and contact information for the facility contact person responsible for source compliance with this rule.

OWNER AND OPERATOR

Enter the name of the owner and operator of the facility for which this application is being prepared. For individual owners, list the full name (last, middle initial, first). For multiple ownership where no legal business partnership exists, provide the name and mailing address, if different, of each individual owner using a backslash (\) to separate data for each owner. For corporations, include divisions or subsidiary name, if any. Enter the complete mailing address of the owner and operator.

Provide name and contact information for the contact person authorized to receive requests for data and information.

PROCEDURE FOR ESTIMATING EMISSIONS

The initial registration and annual registration must include an estimate of actual emissions taking into account equipment, operating conditions, and air pollution control measures. For an existing air pollution source that operated during the calendar year preceding the initial registration or annual registration submittal, the actual emissions are the actual rate of emissions for the preceding calendar year and must be calculated using the actual operating hours, production rates, in-place control equipment, and types of materials processed, stored, or combusted during the preceding calendar year. For a new air pollution source that is submitting its initial registration, the actual emissions are the estimated actual rate of emissions for the current calendar year. The emission estimates must be based upon actual test data or, in the absence of such data, upon procedures acceptable to the Regional Administrator. Any emission estimates submitted to the Regional Administrator must be verifiable using currently accepted engineering criteria. The following procedures are generally acceptable for estimating emissions from air pollution sources:

(i) Source-specific emission tests;

(ii) Mass balance calculations;

(iii) Published, verifiable emission factors that are applicable to the source;

(iv) Other engineering calculations; or

(v) Other procedures to estimate emissions specifically approved by the Regional Administrator.

EPA Form 7630-6 Page 1 of 5