EPA Form 5900-233 Optional Form for Request for Extension of Use of Best A

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OMB Control No. 2060-0629
Approval expires 11/30/2012
United States Environmental Protection Agency
Washington, DC 20460

Optional Form for Request for Extension of Use of Best Available
Monitoring Methods
Hydrogen Production (Subpart P), Petrochemical Production
(Subpart X) and Petroleum Refineries (Subpart Y)
Mandatory Reporting of Greenhouse Gases (40 CFR Part 98)
Office of Atmospheric Programs

General Information: If you are an owner or operator subject to 40 CFR 98 Subparts P
(Hydrogen Production), X (Petrochemical Production), or Y (Petroleum Refineries) you may
request to extend the use of best available monitoring methods (BAMM) through December 31,
2013 for any process equipment or unit that operates continuously and for which it is not
reasonably feasible to install a required measurement device without a process equipment or unit
shutdown, or through a hot tap. You may also request a one-time BAMM extension past
December 31, 2013, not to extend beyond December 31, 2015. To obtain approval, you must
have received previous approval to use BAMM beyond July 1, 2011. This entailed filing an
initial notice of intent to EPA by January 1, 2011 and a complete extension request by February
15, 2011. The extension request must demonstrate to the EPA Administrator's satisfaction that it
is not practicable to isolate the process equipment or unit and install the measurement equipment
without a full shutdown or hot tap.
To submit your extension request to the EPA Administrator for the use of BAMM under Part 98
Subpart A (40 CFR 98.3(j)), you have the option of using the form that follows this page. You
must submit your request for an extension under 98.3(j)(3)(ii) within 4 weeks of identifying the
need to extend the request, but in any event no later than 4 weeks before the date for the planned
process equipment or unit shutdown that was provided in the previous request. You must submit
your request for a one-time extension beyond December 31, 2013, under 98.3(j)(7), by June 1,
2013.

Effective immediately, any future BAMM requests must be submitted in hard copy to one of the
following addresses:
For package delivery (Preferred): Carole Cook, c/o Director, Climate Change Division,
U.S. Environmental Protection Agency, 1310 L Street, NW, 802e, Washington, DC
20005. Phone: 202-343-9263
For U.S. mail: Carole Cook, c/o Director, Climate Change Division, U.S. Environmental
Protection Agency, 1200 Pennsylvania Avenue, NW, Mail Code: 6207J, Washington,
DC 20460

EPA Form 5900-233

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OMB Control No. 2060-0629
Approval expires 11/30/2012

Upon receipt, the extension request will be recorded in the EPA tracking system, and the
requester will be notified that EPA is evaluating the request. EPA will evaluate your request to
confirm that it is consistent with §98.3(j). The agency will then notify you to confirm approval
or denial of the application. As a general matter, EPA will base its decision on the information
provided in the timely extension request and does not intend to negotiate on specific issues, or
necessarily follow-up with the requester regarding missing data. As time allows, however, EPA
may follow up on extension requests with additional questions.

The public reporting and recordkeeping burden for this collection of information is estimated to
average 30 minutes per response (the burden was already included in ICR 200909-2060-007). This is
an optional application form. 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.

EPA Form 5900-233

Mandatory Reporting of Greenhouse Gases (40 CFR Part 98)
Optional Facility Form For Requesting an Extension of Use of Best Available Monitoring Methods
for Subparts P (Hydrogen Production), X (Petrochemical Production), and Y (Petroleum
Refineries)
General Information
1. Name of Person to Contact about the Request
2. Contact Person Address (include street address,
city, state, and zip code)
3. Contact Person Phone Number
4. Contact Person Email Address
5. Signature:
“I am authorized to make this submission on behalf of
the owners and operators of the facility or supplier, as
applicable, 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.”
Note: The designated representative or alternate
designated representative must sign (i.e. agree to) this
certification statement. If you are an agent you are not
agreeing to the certification statement, but are
submitting the certification statement on behalf of the
designated representative or alternate designated
representative who is agreeing to the certification
statement. An agent is only authorized to make the
submission on behalf of the designated representative,
not to sign (i.e., agree to) the certification statement.
[All submissions must be submitted by the DR, an
alternative DR or an Agent- see §98.4(e) and §98.4(m).
Please include the DR, ADR or Agent signature here.]

6. Date Signed
7. Date Submitted

Facility and Emissions Unit Information
8. Facility Name
9. Facility Physical Address (include street address,
city, state, and zip code)
10. Unit ID or Group ID, Common Pipe ID or
Common Stack ID (list for each applicable unit)

EPA Form 5900-233

Mandatory Reporting of Greenhouse Gases (40 CFR Part 98)
Optional Facility Form For Requesting an Extension of Use of Best Available Monitoring Methods
for Subparts P (Hydrogen Production), X (Petrochemical Production), and Y (Petroleum
Refineries)
11. Type of Unit (e.g., boiler, process heater)
12. Total Number of Units at Facility Included in this
Application

Measurement Device and Rule Requirement Information
13. Measurement Device(s) Description (list all)
14. Parameter (e.g., process emissions, process offgas, fuel combusted)
15. Rule Subpart (P, X, Y)
16. Rule Citation for Monitoring Requirement (e.g.,
(e.g., §98.253(b)(1)(ii) or §98.33(a)(2)(ii))

Identification of Equipment Location
17. Location where each measurement device will be
installed. Please indicate if documentation (e.g., a
diagram) for the unit with monitor or sampling
location is attached. (Indicate whether you are
including attachments and include a list of files
attached.)

Reason for the Extension Request
18. Reason for the Extension Request (e.g., why the
needed equipment could not be installed by the
expiration date for the previously granted extension
under §98.3(j)).
19. Please provide supporting documentation showing
that it is not practicable to isolate the process
equipment or unit and install the measurement
device without a full shutdown or hot tap and that
there was no opportunity to install the device by the
expiration date for the previously granted extension
under §98.3(j). (Indicate whether you are including
attachments and include a list of files attached.)
19a. Dates of three (3) most recent shutdowns for
each relevant process equipment or unit.
19b. If there was a shutdown since the previously
approved extension explain why the
measurement device was not obtained and
installed during that shutdown.
19c. What is the typical frequency of shutdowns
for each relevant process equipment or unit?

EPA Form 5900-233

1.
2.
3.

Mandatory Reporting of Greenhouse Gases (40 CFR Part 98)
Optional Facility Form For Requesting an Extension of Use of Best Available Monitoring Methods
for Subparts P (Hydrogen Production), X (Petrochemical Production), and Y (Petroleum
Refineries)
20. Date of next planned shutdown for each relevant
process equipment or unit during which the
measurement device could be installed.

Proposed Best Available Monitoring Method Information
21. Provide a description of the proposed best
available monitoring method for estimating GHG
emissions during the time prior to installation of
the meter (or measurement device). Include
information about why the proposed method is
appropriate (you may attach additional pages).

Additional Information Required for Subsequent Extension Requests (§98.3(j)(3)(ii)) and
One-Time Extension Requests (§98.3(j)(7))
22. If this application is being filed under
§98.3(j)(3)(ii), is it being submitted within 4
weeks of the owner or operator identifying the
need to extend the request, but in any event no
later than 4 weeks before the date of the planned
process equipment or unit shutdown that was
provided in the previous request? (yes/no)
23. On what date did the owner or operator identify
the need to submit under §98.3(j)(3)(ii)?
24. Please indicate the planned shutdown date in the
extension request most recently approved by
EPA under §98.3(j).
25. Is this application being filed under 98.3(j)(7) for
a one time extension past December 31, 2013?
(yes/no)

EPA Form 5900-233