7630-6 Report Of Closure

Form Approved OMB 2060-0558 Approval Expires 5/31/2011

UNITED 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.

A. GENERAL INFORMATION
1. 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 _____________________________

EPA Form 7630-6

Page 1 of 5

Form Approved OMB 2060-0558 Approval Expires 5/31/2011

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 _______________________________

EPA Form 7630-6

Page 2 of 5

Form Approved OMB 2060-0558 Approval Expires 5/31/2011

B. REPORT OF CLOSURE.
1. 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.

EPA Form 7630-6

Page 3 of 5

Form Approved OMB 2060-0558 Approval Expires 5/31/2011

C. OWNER OR OPERATOR CERTIFICATION OF TRUTH, ACCURACY AND
COMPLETENESS
1. 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 (____)________-___________
2. Certification of Truth, Accuracy and Completeness: The Certifying Official must sign this statement after the
form is completed for each applicable requirement.
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
5.61 hours on average. 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.

EPA Form 7630-6

Page 4 of 5

Form Approved OMB 2060-0558 Approval Expires 5/31/2011

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 5 of 5