EPA Form 7610-1 Certificate of Representation

United States Environmental Protection Agency
OMB Nos. 2060-0258, 2060-0570, and 2060-0667
Acid Rain, CAIR, and Transport Rule Trading Programs
Approval Expires 07/31/2014

Certificate of Representation
For more information, see instructions and 40 CFR 72.24, 96.113, 96.213, 96.313, 97.113, 97.213, 97.313, 97.416,
97.516, 97.616, 97.716, or a comparable state regulation, as applicable.
This submission is:

□

New

□

Revised (revised submissions must be complete; see instructions)

FACILITY (SOURCE)
INFORMATION
STEP 1
Provide
information for
the facility
(source).

Facility (Source) Name

State

County Name

STEP 2
Enter requested
information for
the
designated
representative.

Latitude

Longitude

Name

Title

Company Name

Mailing Address

Phone Number

Fax Number

E-mail address

STEP 3
Enter requested
information for
the
alternate
designated
representative.

Name

Title

Company Name

Mailing Address

Phone Number

E-mail address

EPA Form 7610-1 (Revised 8-2011)

Fax Number

Plant Code

Certificate of Representation
Page 2 of 7

UNIT INFORMATION
STEP 4: Complete a separate page 2 for each unit located at the facility identified in STEP 1 (i.e., for each boiler, simple cycle combustion turbine, or combined cycle
combustion turbine) Do not list duct burners. Indicate each program to which the unit is subject, and enter all other unit-specific information. See instructions for more details.
Applicable Program(s):




Acid Rain
TR NOx Annual




CAIR NOX Annual
TR NOx Ozone Season






CAIR SO2

CAIR NOX Ozone Season

TR SO2 Annual
Generator
ID Number
(Maximum
8
characters)

Acid Rain Nameplate
Capacity (MWe)

CAIR/Transport Rule
Nameplate Capacity (MWe)

Source Category

Unit ID#

Unit Type

NAICS Code

Date unit began (or will begin) serving any generator producing electricity for sale (including test
generation) (mm/dd/yyyy):
):
Check One:


Projected 

Actual

Is this unit located in Indian
Country?

If this is the first time the unit has been identified on the Certificate of
Representation for this facility, was the unit moved from another facility?
Check One:

Check One:
Yes
No




Yes
No




Company Name:

 Owner
 Operator

Company Name:

 Owner
 Operator

Company Name:

 Owner
 Operator

Company Name:

 Owner
 Operator

Company Name:

 Owner
 Operator

EPA Form 7610-1 (Revised 8-2011)

Certificate of Representation
Page 3 of 7

STEP 5: Read the appropriate certification statements, sign, and date.
Acid Rain Program
I certify that I was selected as the designated representative or alternate designated representative (as applicable) by
an agreement binding on the owners and operators of the affected source and each affected unit at the source (i.e., the
source and each unit subject to the Acid Rain Program, as indicated in "Applicable Program(s)" in Step 4).
I certify that I have all necessary authority to carry out my duties and responsibilities under the Acid Rain Program on
behalf of the owners and operators of the affected source and each affected unit at the source and that each such
owner and operator shall be fully bound by my representations, actions, inactions, or submissions.
I certify that the owners and operators of the affected source and each affected unit at the source shall be bound by any
order issued to me by the Administrator, the permitting authority, or a court regarding the source or unit.
Where there are multiple holders of a legal or equitable title to, or a leasehold interest in, an affected unit, or where a
utility or industrial customer purchases power from an affected unit under a life-of-the-unit, firm power contractual
arrangement,
I certify that:
I have given a written notice of my selection as the designated representative or alternate designated
representative (as applicable) and of the agreement by which I was selected to each owner and
operator of the affected source and each affected unit at the source; and
Allowances, and proceeds of transactions involving allowances, will be deemed to be held or distributed
in proportion to each holder's legal, equitable, leasehold, or contractual reservation or entitlement,
except that, if such multiple holders have expressly provided for a different distribution of allowances,
allowances and proceeds of transactions involving allowances will be deemed to be held or distributed
in accordance with the contract.

Clean Air Interstate Rule (CAIR) NOX Annual Trading Program
I certify that I was selected as the CAIR designated representative or alternate CAIR designated representative (as
applicable), by an agreement binding on the owners and operators of the CAIR NOX source and each CAIR NOX unit at
the source (i.e., the source and each unit subject to the CAIR NOX Annual Trading Program, as indicated in "Applicable
Program(s)" in Step 4).
I certify that I have all necessary authority to carry out my duties and responsibilities under the CAIR NOX Annual
Trading Program on behalf of the owners and operators of the CAIR NOX source and each CAIR NOX unit at the source
and that each such owner and operator shall be fully bound by my representations, actions, inactions, or submissions.
I certify that the owners and operators of the CAIR NOX source and each CAIR NOX unit at the source shall be bound by
any order issued to me by the Administrator, the permitting authority, or a court regarding the source or unit.
Where there are multiple holders of a legal or equitable title to, or a leasehold interest in, a CAIR NOX unit, or where a
utility or industrial customer purchases power from a CAIR NOX unit under a life-of-the-unit, firm power contractual
arrangement,
I certify that:
I have given a written notice of my selection as the CAIR designated representative or alternate CAIR
designated representative (as applicable) and of the agreement by which I was selected to each owner
and operator of the CAIR NOX source and each CAIR NOX unit at the source; and
CAIR NOX allowances and proceeds of transactions involving CAIR NOX allowances will be deemed to
be held or distributed in proportion to each holder's legal, equitable, leasehold, or contractual
reservation or entitlement, except that, if such multiple holders have expressly provided for a different
distribution of CAIR NOX allowances by contract, CAIR NOX allowances and proceeds of transactions
involving CAIR NOX allowances will be deemed to be held or distributed in accordance with the
contract.

EPA Form 7610-1 (Revised 8-2011)

Certificate of Representation
Page 4 of 7

Clean Air Interstate Rule (CAIR) SO2 Trading Program
I certify that I was selected as the CAIR designated representative or alternate CAIR designated representative (as
applicable), by an agreement binding on the owners and operators of the CAIR SO2 source and each CAIR SO2 unit at
the source (i.e., the source and each unit subject to the SO2 Trading Program, as indicated in "Applicable Program(s)" in
Step 4).
I certify that I have all necessary authority to carry out my duties and responsibilities under the CAIR SO2 Trading
Program, on behalf of the owners and operators of the CAIR SO2 source and each CAIR SO2 unit at the source and that
each such owner and operator shall be fully bound by my representations, actions, inactions, or submissions.
I certify that the owners and operators of the CAIR SO2 source and each CAIR SO2 unit at the source shall be bound by
any order issued to me by the Administrator, the permitting authority, or a court regarding the source or unit.
Where there are multiple holders of a legal or equitable title to, or a leasehold interest in, a CAIR SO2 unit, or where a
utility or industrial customer purchases power from a CAIR SO2 unit under a life-of-the-unit, firm power contractual
arrangement,
I certify that:
I have given a written notice of my selection as the CAIR designated representative or alternate CAIR
designated representative (as applicable) and of the agreement by which I was selected to each owner
and operator of the CAIR SO2 source and each CAIR SO2 unit at the source; and
CAIR SO2 allowances and proceeds of transactions involving CAIR SO2 allowances will be deemed to be held
or distributed in proportion to each holder's legal, equitable, leasehold, or contractual reservation or entitlement,
except that, if such multiple holders have expressly provided for a different distribution of CAIR SO2 allowances
by contract, CAIR SO2 allowances and proceeds of transactions involving CAIR SO2 allowances will be deemed
to be held or distributed in accordance with the contract.
Clean Air Interstate Rule (CAIR) NOX Ozone Season Trading Program
I certify that I was selected as the CAIR designated representative or alternate CAIR designated representative (as
applicable), by an agreement binding on the owners and operators of the CAIR NOX Ozone Season source and each
CAIR NOX Ozone Season unit at the source (i.e., the source and each unit subject to the CAIR NOX Ozone Season
Trading Program, as indicated in "Applicable Program(s)" in Step 4).
I certify that I have all necessary authority to carry out my duties and responsibilities under the CAIR NOX Ozone
Season Trading Program on behalf of the owners and operators of the CAIR NOX Ozone Season source and each
CAIR NOX Ozone Season unit at the source and that each such owner and operator shall be fully bound by my
representations, actions, inactions, or submissions.
I certify that the owners and operators of the CAIR NOX Ozone Season source and each CAIR NOX Ozone Season unit
shall be bound by any order issued to me by the Administrator, the permitting authority, or a court regarding the source
or unit.
Where there are multiple holders of a legal or equitable title to, or a leasehold interest in, a CAIR NO X Ozone Season
unit, or where a utility or industrial customer purchases power from a CAIR NOX Ozone Season unit under a life-of-theunit, firm power contractual arrangement, I certify that:
I have given a written notice of my selection as the CAIR designated representative or alternate CAIR
designated representative (as applicable) and of the agreement by which I was selected to each owner
and operator of the CAIR NOX Ozone Season source and each CAIR NOX Ozone Season unit; and
CAIR NOX Ozone Season allowances and proceeds of transactions involving CAIR NOX Ozone Season
allowances will be deemed to be held or distributed in proportion to each holder's legal, equitable,
leasehold, or contractual reservation or entitlement, except that, if such multiple holders have expressly
provided for a different distribution of CAIR NOX Ozone Season allowances by contract, CAIR NOX
Ozone Season allowances and proceeds of transactions involving CAIR NOX Ozone Season
allowances will be deemed to be held or distributed in accordance with the contract.

EPA Form 7610-1 (Revised 8-2011)

Certificate of Representation
Page 5 of 7

Transport Rule NOx Annual Trading Program
I certify that I was selected as the designated representative or alternate designated representative, as applicable, by an
agreement binding on the owners and operators of the source and each TR NOX Annual unit at the source.
I certify that I have all the necessary authority to carry out my duties and responsibilities under the TR NOX Annual
Trading Program on behalf of the owners and operators of the source and of each TR NOX Annual unit at the source
and that each such owner and operator shall be fully bound by my representations, actions, inactions, or submissions
and by any order issued to me by the Administrator regarding the source or unit.
Where there are multiple holders of a legal or equitable title to, or a leasehold interest in, a TR NOX Annual unit, or
where a utility or industrial customer purchases power from a TR NOX Annual unit under a life-of-the-unit, firm power
contractual arrangement, I certify that:
I have given a written notice of my selection as the ‘designated representative’ or ‘alternate designated
representative’, as applicable, and of the agreement by which I was selected to each owner and operator of the
source and of each TR NOX Annual unit at the source.
TR NOX Annual allowances and proceeds of transactions involving TR NOX Annual allowances will be deemed
to be held or distributed in proportion to each holder's legal, equitable, leasehold, or contractual reservation or
entitlement, except that, if such multiple holders have expressly provided for a different distribution of TR NOX
Annual allowances by contract, TR NOX Annual allowances and proceeds of transactions involving TR NOX
Annual allowances will be deemed to be held or distributed in accordance with the contract.

Transport Rule NOx Ozone Season Trading Program
I certify that I was selected as the designated representative or alternate designated representative, as applicable, by an
agreement binding on the owners and operators of the source and each TR NOX Ozone Season unit at the source.
I certify that I have all the necessary authority to carry out my duties and responsibilities under the TR NOX Ozone
Season Trading Program on behalf of the owners and operators of the source and of each TR NOX Ozone Season unit
at the source and that each such owner and operator shall be fully bound by my representations, actions, inactions, or
submissions and by any order issued to me by the Administrator regarding the source or unit.
Where there are multiple holders of a legal or equitable title to, or a leasehold interest in, a TR NOX Ozone Season unit,
or where a utility or industrial customer purchases power from a TR NOX Ozone Season unit under a life-of-the-unit,
firm power contractual arrangement, I certify that:
I have given a written notice of my selection as the ‘designated representative’ or ‘alternate designated
representative’, as applicable, and of the agreement by which I was selected to each owner and operator of the
source and of each TR NOX Ozone Season unit at the source.
TR NOX Ozone Season allowances and proceeds of transactions involving TR NOX Ozone Season allowances
will be deemed to be held or distributed in proportion to each holder's legal, equitable, leasehold, or contractual
reservation or entitlement, except that, if such multiple holders have expressly provided for a different
distribution of TR NOX Ozone Season allowances by contract, TR NOX Ozone Season allowances and
proceeds of transactions involving TR NOX Ozone Season allowances will be deemed to be held or distributed
in accordance with the contract.

EPA Form 7610-1 (Revised 8-2011)

Certificate of Representation
Page 6 of 7

Transport Rule SO2 Annual Group 1 Trading Program
I certify that I was selected as the designated representative or alternate designated representative, as applicable, by an
agreement binding on the owners and operators of the source and each TR SO2 Group 1 unit at the source.
I certify that I have all the necessary authority to carry out my duties and responsibilities under the TR SO2 Group 1
Trading Program on behalf of the owners and operators of the source and of each TR SO2 Group 1 unit at the source
and that each such owner and operator shall be fully bound by my representations, actions, inactions, or submissions
and by any order issued to me by the Administrator regarding the source or unit.
Where there are multiple holders of a legal or equitable title to, or a leasehold interest in, a TR SO2 Group 1 unit, or
where a utility or industrial customer purchases power from a TR SO2 Group 1 unit under a life-of-the-unit, firm power
contractual arrangement, I certify that:
I have given a written notice of my selection as the ‘designated representative’ or ‘alternate designated
representative’, as applicable, and of the agreement by which I was selected to each owner and operator of the
source and of each TR SO2 Group 1 unit at the source.
TR SO2 Group 1 allowances and proceeds of transactions involving TR SO2 Group 1 allowances will be
deemed to be held or distributed in proportion to each holder's legal, equitable, leasehold, or contractual
reservation or entitlement, except that, if such multiple holders have expressly provided for a different
distribution of TR SO2 Group 1 allowances by contract, TR SO2 Group 1 allowances and proceeds of
transactions involving TR SO2 Group 1 allowances will be deemed to be held or distributed in accordance with
the contract.

Transport Rule SO2 Annual Group 2 Trading Program
I certify that I was selected as the designated representative or alternate designated representative, as applicable, by an
agreement binding on the owners and operators of the source and each TR SO2 Group 2 unit at the source.
I certify that I have all the necessary authority to carry out my duties and responsibilities under the TR SO2 Group 2
Trading Program on behalf of the owners and operators of the source and of each TR SO2 Group 2 unit at the source
and that each such owner and operator shall be fully bound by my representations, actions, inactions, or submissions
and by any order issued to me by the Administrator regarding the source or unit.
Where there are multiple holders of a legal or equitable title to, or a leasehold interest in, a TR SO2 Group 2 unit, or
where a utility or industrial customer purchases power from a TR SO2 Group 2 unit under a life-of-the-unit, firm power
contractual arrangement, I certify that:
I have given a written notice of my selection as the ‘designated representative’ or ‘alternate designated
representative’, as applicable, and of the agreement by which I was selected to each owner and operator of the
source and of each TR SO2 Group 2 unit at the source.
TR SO2 Group 2 allowances and proceeds of transactions involving TR SO2 Group 2 allowances will be
deemed to be held or distributed in proportion to each holder's legal, equitable, leasehold, or contractual
reservation or entitlement, except that, if such multiple holders have expressly provided for a different
distribution of TR SO2 Group 2 allowances by contract, TR SO2 Group 2 allowances and proceeds of
transactions involving TR SO2 Group 2 allowances will be deemed to be held or distributed in accordance with
the contract.

EPA Form 7610-1 (Revised 8-2011)

Certificate of Representation
Page 7 of 7

General
I am authorized to make this submission on behalf of the owners and operators of the source or units for which the
submission is made. I certify under penalty of law that I have personally examined, and am familiar with, the statements
and information submitted in this document and all its attachments. Based on my inquiry of those individuals with primary
responsibility for obtaining the information, I certify that the statements and information are to the best of my knowledge
and belief true, accurate, and complete. I am aware that there are significant penalties for submitting false statements and
information or omitting required statements and information, including the possibility of fine or imprisonment.

Signature (Designated Representative)

Date

Signature (Alternate Designated Representative)

Date

EPA Form 7610-1 (Revised 8-2011)

Instructions for the Certificate of Representation
Note: The Certificate of Representation information can be submitted online through the
CAMD Business System (CBS) at https://camd.epa.gov/cbs/index.cfm. You must have a
user ID and password. If you need a user ID and password, call Karen Van Sickle at (202) 3439220 or Kirk Nabors at (202) 343-9171 or Paula Branch at (202) 343-9168. If you have
questions about CBS, contact Laurel DeSantis at [email protected] or (202) 343-9191,
or Alex Salpeter at [email protected] or (202) 343-9157.
Any reference in these instructions to the Designated Representative means the Acid Rain
Designated Representative, the CAIR Designated Representative, and/or Transport Rule
Designated Representative, as applicable. Any reference to the Alternate Designated
Representative means the Alternate Acid Rain Designated Representative, the Alternate CAIR
Designated Representative, and/or the Alternate Transport Rule Designated Representative, as
applicable. As reflected in this form, the Acid Rain Designated Representative, the CAIR
Designated Representative, and the Transport Rule Designated Representative for a facility
(source) must be the same individual, and the Alternate Acid Rain Designated Representative,
the Alternate CAIR Designated Representative, and the Alternate Transport Rule Designated
Representative for a facility (source) must be the same individual.
Please type or print. Submit a separate page 2 for each unit subject to the Acid Rain Program,
a CAIR Trading Program, or a Transport Rule Program at the facility (source), and indicate the
page order and total number of pages (e.g., 1 of 4, 2 of 4, etc.) in the boxes in the upper right
hand corner of page 2. A Certificate of Representation amending an earlier submission
supersedes the earlier submission in its entirety and must therefore always be complete.
Submit one Certificate of Representation form with original signature(s). NO FIELDS SHOULD
BE LEFT BLANK. For assistance, contact Laurel DeSantis at [email protected] or (202)
343-9191.
STEP 1
(i) A Plant Code is a 4 or 5 digit number assigned by the Department of Energy=s (DOE) Energy
Information Administration (EIA) to facilities that generate electricity. For older facilities, "Plant
Code" is synonymous with "ORISPL" and "Facility" codes. If the facility generates electricity but
no Plant Code has been assigned, or if there is uncertainty regarding what the Plant Code is,
send an email to the EIA. The email address is [email protected]. For facilities that do not
produce electricity, use the facility identifier assigned by EPA (beginning with "88"). If the facility
does not produce electricity and has not been assigned a facility identifier, contact Laurel
DeSantis at [email protected] or (202) 343-9191.
(ii) Enter the latitude and longitude representing the location of the facility in degree decimal
format.
Note that coordinates MUST be submitted in decimal degree format; in this format minutes and
seconds are represented as a decimal fraction of one degree. Therefore, coordinates
containing degrees, minutes, and seconds must first be converted using the formula:
decimal degrees = degrees + (minutes / 60) + (seconds / 3600)

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Example:
39 degrees, 15 minutes, 25 seconds = 39 + (15 / 60) + (25 / 3600) = 39.2569 degrees
STEPS 2 & 3
The Designated Representative and the Alternate Designated Representative must be
individuals (i.e., natural persons) and cannot be a company. Enter the company name and
address of the representative as it should appear on all correspondence. If an email address is
provided, most correspondence will be emailed. Although not required, EPA strongly
encourages owners and operators to designate an Alternate Designated Representative
to act on behalf of the Designated Representative.
STEP 4
(i) Complete one page for each unit subject to the Acid Rain Program, a CAIR Trading
Program, or a Transport Rule Program, and indicate the program(s) to which the unit is subject.
Identify each unit at the facility by providing the appropriate unit identification number, consistent
with the identifiers used in previously submitted Certificates of Representation (if applicable) and
with submissions made to DOE and/or EIA. Do not list duct burners. For new units without
identification numbers, owners and operators must assign identifiers consistent with EIA and
DOE requirements. Each submission to EPA that includes the unit identification number(s)
(e.g., monitoring plans and quarterly reports) should reference those unit identification numbers
in exactly the same way that they are referenced on the Certificate of Representation. Do not
identify units that are not subject to the above-listed programs but are part of a common
monitoring configuration with a unit that is subject to any of these programs. To identify units in
a common monitoring configuration that are not subject to any of these programs, call the
CAMD Hotline at (202) 343-9620, and leave a message under the “Continuous Emissions
Monitoring” submenu.
(ii) Identify the type of unit using one of the following abbreviations:
Boilers

Boilers

Turbines

AF

Arch-fired boiler

OB

Other boiler

CC

Combined cycle

BFB

Bubbling fluidized bed
boiler

PFB

Pressurized
fluidized bed boiler

CT

Combustion turbine

C

Cyclone boiler

S

Stoker

OT

Other turbine

CB

Cell burner boiler

T

Tangentially-fired
boiler

Others

CFB

Circulating fluidized
bed boiler

WBF

Wet bottom wallfired boiler

ICE

Internal
combustion engine

DB

Dry bottom wall-fired
boiler

WBT

Wet bottom turbofired boiler

KLN

Cement kiln

DTF

Dry bottom turbo-fired
boiler

WVF

Wet bottom
vertically-fired boiler

PRH

Refinery process
heater

DVF

Dry bottom verticallyfired boiler

If there is uncertainty about how a unit should be characterized, contact Robert Miller at
[email protected] or (202) 343-9077.

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(iii) Indicate the source category description that most accurately describes the purpose for
which the unit is operated by entering one of the following terms. If none of these descriptions
applies to your unit, contact Robert Miller at [email protected] or (202) 343-9077.
Automotive Stampings
Bulk Industrial Chemical
Cement Manufacturing
Cogeneration
Electric Utility

Industrial Boiler
Industrial Turbine
Institutional
Iron and Steel
Municipal Waste Combustor

Petroleum Refinery
Portland Cement Plant
Pulp and Paper Mill
Small Power Producer
Theme Park

(iv) Provide the primary North American Industrial Classification System (NAICS) code that
most accurately describes the business type for which the unit is operated. If unknown, go to
http://www.census.gov for guidance on how to determine the proper NAICS code for the unit.
(v) Enter the date the unit began (or will begin) serving any generator producing electricity for
sale, including test generation. Enter this date and check the "actual" box for any unit that has
begun to serve a generator producing electricity for sale as of the date of submission of this
form. (This information should be provided even if the unit does not currently serve a generator
producing electricity for sale.) For any unit that will begin, but has not begun as of the date of
submission of this form, to serve a generator producing electricity for sale, estimate the future
date on which the unit will begin to produce electricity for sale and check the "projected" box.
When the actual date is established, revise the form accordingly by entering the actual date and
checking the "actual" box. Enter "NA" if the unit has not ever served, is not currently serving,
and is not projected to serve, a generator that producing electricity for sale. You are strongly
encouraged to use the CAMD Business System to update information regarding when a
unit begins serving a generator producing electricity for sale.
If you have questions regarding this portion of the form, contact Robert Miller at
[email protected] or (202) 343-9077.
(vi) For a unit subject to the Acid Rain Program, a CAIR Trading Program, or a Transport Rule
Program, that, as of the date of submission of this form, serves one or more generators
(whether or not the generator produces electricity for sale), indicate the generator ID number
and the nameplate capacity (in MWe) of each generator served by the unit. A unit serves a
generator if it produces, or is able to produce, steam, gas, or other heated medium for
generating electricity at that generator. For combined cycle units, report separately the
nameplate capacities of the generators associated with the combustion turbine and the steam
turbine. Please ensure that the generator ID numbers entered are consistent with those
reported to the EIA.
The definitions of "nameplate capacity" under the Acid Rain Program and under the
CAIR/Transport Rule Programs differ slightly. Therefore, for a unit subject to the Acid Rain
Program and any CAIR/Transport Rule Program, the nameplate capacity for the same
generator under the Acid Rain Program and under the CAIR/Transport Rule Program may differ
in certain limited circumstances. Specifically, for a unit subject to the Acid Rain Program, the
nameplate capacity of a generator, if listed in the National Allowance Database ("NADB"), is not
affected by physical changes to the generator after initial installation that result in an increase in
the maximum electrical generating output that the generator is capable of producing.
Otherwise, for a unit subject to the Acid Rain Program or a CAIR/Transport Rule Program, the
nameplate capacity of a generator is affected by physical changes to the generator after initial
installation that result in an increase in the maximum electrical generating output that the
generator is capable of producing. In such a case, the higher maximum electrical generating
output number in MWe should be reported in the nameplate capacity column. Enter "NA" if, as
of the date of submission of this form, the unit does not serve a generator.

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See the definition of "nameplate capacity" at 40 CFR 72.2, 96.102, 97.102, 96.202, 97.202,
96.302, 97.302, 97.402, 97.502, 97.602, and 97.702, as applicable. The NADB is located at the
CAMD website at http://www.epa.gov/airmarkets/trading/allocations.html. If you have questions
regarding nameplate capacity, contact Robert Miller at [email protected] or (202) 3439077; if you have questions regarding the NADB, contact Craig Hillock at [email protected]
or (202) 343-9105.
(vii) Enter the company name of each owner and operator in the "Company Name" field.
Indicate whether the company is the owner, operator, or both. For new units, if the operator of a
unit has not yet been chosen, indicate that the owner is both the owner and operator and submit
a revised form when the operator has been selected within 30 days of the effective date of the
selection. EPA must be notified of changes to owners and operators within 30 days of the
effective date of the change. You are strongly encouraged to use the CAMD Business
System to provide updated information on owners and operators.
(viii) Indicate whether or not the unit is located in Indian Country. For more information see the
definition of “Indian Country” at 40 CFR 97.402, 97.502, 97.602 and 97.702.
(ix) When identifying a unit at a facility for the first time, indicate whether or not the unit was
moved from another facility. If the answer is “yes”, the EPA will contact the owners/operator for
more information.
STEP 5
Read the appropriate certification statements, sign, and date.
Mail this form to:
For regular/certified mail:

For overnight mail:

U.S. Environmental Protection Agency
Clean Air Markets Division (6204J)
Attention: Designated Representative
1200 Pennsylvania Avenue, NW
Washington, DC 20460

U.S. Environmental Protection Agency
Clean Air Markets Division (6204J)
Attention: Designated Representative
1310 L Street, NW
Second Floor
Washington, DC 20005
(202) 343-9191

Submit this form prior to making any other submissions under the Acid Rain Program,
CAIR Programs, or Transport Rule Programs. Submit a revised Certificate of Representation
when any information in the existing Certificate of Representation changes. You are strongly
encouraged to use the CAMD Business System to provide updated information.
Paperwork Burden Estimate
The public reporting and record keeping burden for this collection of information is estimated to
average 15 hours per response annually. Burden means the total time, effort, or financial
resources expended by persons to generate, maintain, retain, or disclose or provide information
to or for a Federal agency. This includes the time needed to review instructions; develop,
acquire, install, and utilize technology and systems for the purposes of collecting, validating, and
verifying information, processing and maintaining information, and disclosing and providing
information; adjust the existing ways to comply with any previously applicable instructions and
requirements; train personnel to be able to respond to a collection of information; search data

4

sources; complete and review the collection of information; and transmit or otherwise disclose
the information. An agency may not conduct or sponsor, and a person is not required to
respond to, a collection of information unless it displays a currently valid OMB control number.
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, U.S.
Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW., Washington, D.C.
20460. Include the OMB control number in any correspondence. Do not send the completed
form to this address.

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