5900-05 PDR, Prompt Deviation Report

OMB No. 2060-0336, Approval Expires 04/30/2012

Federal Operating Permit Program (40 CFR Part 71)
PROMPT DEVIATION REPORT (PDR)
Section A (General Information)
Permit No. ____________________
Source / Company Name ___________________________________________________________
Mailing Address: Street or P.O. Box ________________________________________________
City ________________________________________ State______
Contact person __________________________________

Title ___________________________

Telephone (______) ______ - __________ Ext. ________

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EPA Form 5900-05

ZIP__________ - ______

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Section B (Deviation Report)
This section is for deviations that must be reported in writing within 10 days of occurrence (other types of deviation
may be reported for the first time in the 6-month monitoring report). Report the beginning and ending times
(mo/day/yr, hr:min) for each deviation. Use the 24-hour clock. Briefly explain (if known) the probable cause of each
deviation. If any corrective actions or preventative measures have been taken to avoid these in the future, briefly
describe the measures, including when they occurred.

Permit Term (for Which There is a Deviation):

Emission Units (unit IDs)
Deviation Start: ____/____/________ ____ :____

End: ____/____/_______ ____:____

Probable Cause of Deviation:
Corrective Actions or Preventative Measures Taken:

Permit Term (for Which There is a Deviation):

Emission Units (unit IDs)
Deviation Start: ____/____/________ ____:____

End: ____/____/_______ ____:____

Probable Cause of Deviation:
Corrective Actions or Preventative Measures Taken:

Permit Term (for Which There is a Deviation):

Emission Units (unit IDs)
Deviation Start: ____/____/________ ____:____
Probable Cause of Deviation:
Corrective Actions or Preventative Measures Taken:

EPA Form 5900-05

End: ____/____/_______ ____:____

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INSTRUCTIONS FOR PDR
PROMPT DEVIATION REPORT

Use this form to submit written notice to the part 71 permitting authority of each deviation from permit terms
that is required to be reported within 10 working days of its occurrence (in other words, deviations required to
be reported prior to the 6-month monitoring report). Each form (or multiple forms if sent at the same time)
must be certified as to truth, accuracy, and completeness by a responsible official (using CTAC).
Information Collection Burden Estimates
The public reporting and recordkeeping burden for this collection of information is estimated to average 221
hours per respondent per year. 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.
DETAILED INSTRUCTIONS
This form is designed to serve as the written notice for those deviations required to be reported in writing
within 10 days of their occurrence:
 Where HAP emissions continue for more than one hour in excess of permit requirements, and
 Where non-HAP regulated air pollutants continues for more than two hours in excess of permit
requirements.
Submittal of this form does not relieve you of the requirement to first notify the permitting authority by
telephone or facsimile of these deviations (as may be required in the permit). Other deviations are reported
for the first time in the six-month monitoring report.
Section A (Identifying Information)
The contact person should be a person familiar with the day-to-day operation of the facility, such as a plant
site manager or other individual, who should be available to be contacted by the permitting authority. If there
is more than one contact person, list the others on an attachment.
Section B (Deviation Report)
Deviations from permit terms occur when any permit term is not met, including terms that establish emission
limitations, standards, monitoring, recordkeeping, reporting, and other requirements. See instructions for
SIXMON for more on what constitutes a deviation. A deviation is not necessarily a violation. Violations are
determined by EPA (or its delegate Agency).
You may list multiple emissions units for a single deviation if they relate to the same permit terms and occur
during the same time periods. In addition, for deviations from permit terms that apply to the whole facility,
you may enter Afacility-wide@ to describe the emissions units.
Each 24-hour period of deviation is considered a separate deviation, however, you may indicate continuous
periods of deviation that span multiple days in a single entry. Use the 24-hour clock (equivalent to military
time) for reporting these times (e.g., the day starts and ends at midnight, or 00:00 in military time.
Briefly explain the probable cause of the deviation from permit terms, if known.

EPA Form 5900-05

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If any corrective actions or preventative measures were taken to avoid similar deviations at the same
emissions units, briefly explain them. If known, include dates when such actions or measures were taken or
will be taken in the future.
Form CTAC (Certification of Truth, Accuracy, and Completeness by Responsible Official)
You must complete form CTAC and attach it to this deviation report.

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EPA Form 5900-05