5900-79 GIS, General Information and Summary

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

Federal Operating Permit Program (40 CFR Part 71)
GENERAL INFORMATION AND SUMMARY (GIS)
A. Mailing Address and Contact Information
Facility name ________________________________________________________________
Mailing address: Street or P.O. Box ____________________________________________
City ____________________________________ State _______ ZIP ___________-________
Contact person: __________________________ Title ______________________________
Telephone (______) ________ - ___________ Ext. _________
Facsimile (______) ________ - ___________

B. Facility Location
Temporary source? ___Yes ___No

Plant site location _____________________________________

__________________________________________________________________________________
City ____________________________ State_____ County________________

EPA Region____

Is the facility located within:
Indian lands? ___YES

___ NO

OCS waters? ___YES

Non-attainment area? ___ YES ___NO

___ NO

If yes, for what air pollutants? _________

Within 50 miles of affected State? __ YES __ NO

If yes, What State(s)? _____

C. Owner
Name ________________________________ Street/P.O. Box _________________________
City _______________________________________ State______ ZIP_________ - ________
Telephone (_____) ______ - __________

Ext_________

D. Operator
Name _______________________________ Street/P.O. Box __________________________
City _______________________________________ State ______ ZIP _________ - _______
Telephone (_____) ______ - __________

EPA Form 5900-79

Ext_________

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E. Application Type
Mark only one permit application type and answer the supplementary question appropriate for the type
marked.
___Initial Permit

___ Renewal

___ Group Processing, MPM

___ Significant Mod

___ Minor Permit Mod(MPM)

___ Administrative Amendment

For initial permits, when did operations commence? _____ /_____ /_____
For permit renewal, what is the expiration date of current permit? _____/____/_____

F. Applicable Requirement Summary
Mark all types of applicable requirements that apply.
___ SIP

___ FIP/TIP

___ PSD

___Non-attainment NSR

___ Minor source NSR

___ Section 111

___ Phase I acid rain ___Phase II acid rain

___ Stratospheric ozone

___ OCS regulations

___ NESHAP

___ Sec. 112(g) MACT

___ Early reduction of HAP

___ Sec 112(j) MACT ___ RMP [Sec.112(r)]

___ Sec. 112(d) MACT

___ Tank Vessel requirements, sec. 183(f))

___ Section 129 Standards/Requirement

___ Consumer / comm.. products, ' 183(e)

___ NAAQS, increments or visibility (temp. sources)

Has a risk management plan been registered? ___YES ___NO
Phase II acid rain application submitted? ___YES ___NO

Regulatory agency ____________

If yes, Permitting authority ____________

G. Source-Wide PTE Restrictions and Generic Applicable Requirements
Cite and describe any emissions-limiting requirements and/or facility-wide "generic" applicable requirements.

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H. Process Description
List processes, products, and SIC codes for the facility.
Process

Products

SIC

I. Emission Unit Identification
Assign an emissions unit ID and describe each emissions unit at the facility. Control equipment and/or alternative
operating scenarios associated with emissions units should by listed on a separate line. Applicants may exclude
from this list any insignificant emissions units or activities.
Emissions Unit ID

EPA Form 5900-79

Description of Unit

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J. Facility Emissions Summary
Enter potential to emit (PTE) for the facility as a whole for each air pollutant listed below. Enter the name of the
single HAP emitted in the greatest amount and its PTE. For all pollutants stipulations to major source status
may be indicated by entering "major" in the space for PTE. Indicate the total actual emissions for fee purposes
for the facility in the space provided. Applications for permit modifications need not include actual emissions
information.
NOx ___________ tons/yr
PM-10 ___________ tons/yr

VOC ___________ tons/yr
CO ___________ tons/yr

SO2 ___________ tons/yr
Lead ___________ tons/yr

Total HAP ___________ tons/yr
Single HAP emitted in the greatest amount ________________________

PTE _______ tons/yr

Total of regulated pollutants (for fee calculation), Sec. F, line 5 of form FEE

_____ tons/yr

K. Existing Federally-Enforceable Permits
Permit number(s) _________________

Permit type _____________ Permitting authority __________

Permit number(s) _________________

Permit type _____________ Permitting authority _________

L. Emission Unit(s) Covered by General Permits
Emission unit(s) subject to general permit _______________________________________________
Check one:

___ Application made

___ Coverage granted

General permit identifier ______________________________

Expiration Date ____/____/____

M. Cross-referenced Information
Does this application cross-reference information?

___ YES

INSTRUCTIONS FOLLOW

EPA Form 5900-79

___ NO

(If yes, see instructions)

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INSTRUCTIONS FOR GIS,
GENERAL INFORMATION AND SUMMARY
Use this form to provide general and summary information about the part 71 source (facility or plant)
and to indicate the permitting action requested. Submit this form once for each part 71 source.
Several sections of this form ask for information you may not know until you complete other part 71
forms.
Section A - Enter the facility's official or legal name. The contact person should be a person familiar
with the day-to-day operation of the facility, such as a plant site manager or similar individual.
Section B – If different from the mailing address, include the plant site location.
Sections C and D - If more than one owner or operator, list them on an attachment.
Section E - Mark initial permit issuance if you are applying for the first time. For all types of permit
revisions, applicants must provide a brief narrative description of the changes.
Section F - Indicate the broad categories of applicable requirements that apply to the facility or
any emissions units. Note that acid rain requirements must be included in part 71 permits the
same as other requirements. Also see definition of “applicable requirement” in part 71.
Section G – List emission-limiting requirements that apply to the facility as a whole, such as
restrictions on potential to emit or applicable requirements that apply identically to all emission
units at a facility.
Section H - List, in descending order of priority, the 4-digit standard industrial classification (SIC)
code(s) that best describes your facility in terms of its principal products or processes, and provide
a brief narrative description for each classification. For a listing of SIC codes, see the Standard
Industrial Classification Manual, 1987 edition, prepared by the Executive Office of the President,
Office of Management and Budget, from the Government Printing Office, Washington DC.
Section I - Assign a unique identifier (unit ID) under the "emissions unit ID" column and provide a
text description for each significant emissions unit at facility. These IDs will be used in other part
71 forms. A "significant emissions unit" is any unit that is not an insignificant emission unit or
activities. Note that unit IDs need only be assigned if they will be referenced in subsequent
portions of the application. You may choose any numbering system you wish to assign unit IDs. If
a unit ID was previously assigned, use the original ID. If the unit is a new unit, assign a unit ID
consistent with the existing units’ IDs.
You may group emissions units, activities, or pieces of equipment together and assign a single
unique unit ID when they are subject to the same applicable requirement(s) and will have the same
monitoring, record keeping, and reporting requirements in the permit.
In addition, assign a unit ID for each alternative operating scenario and each piece of pollution
control equipment. When possible, assign these numbers so as to show with which emissions
units or processes these scenarios or control devices are associated.
Section J - Show the total emissions for the source in terms of PTE for applicability purposes for
each air pollutant listed below and the total actual emissions for fee purposes. Applications for
permit revisions should report PTE after the change for the emissions units affected by the change.
Completion of form PTE is recommended prior to the entry of PTE information in this section.

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"NOx" is an abbreviation for nitrogen oxides,
"VOC" is for volatile organic compounds,
"SO2" is for sulfur dioxide,
"PM10" is for particulate matter with an aerodynamic diameter of 10 micrometers or less,
"CO" is for carbon monoxide, and
“Lead” is for elemental lead regulated by a NAAQS (“compounds of lead” are HAP).
Also note that each HAP on the list of HAP in section 112(b) of the Act is a separate regulated air
pollutant.
Include fugitive emissions when reporting PTE to the extent that they count toward major source
applicability. All fugitive emissions of HAP count toward major source applicability.
Sources may also stipulate to major source status for the pollutants indicated on the form by
entering "Major" in the space provided for PTE values.
You may use the value for actual emissions from section F, line 5, of form FEE. When totaling
actual emissions for fee purposes, include all emissions, including fugitive emissions, regardless of
whether they count for applicability purposes.
Section L - If any emissions unit within your facility is applying, has applied, or currently has a
general permit, identify the emissions unit ID and name of the unit, consistent with section I of this
form.
Section M - Attach copies of any cross-referenced documents that are not publicly available or
otherwise available to the permitting authority.

END

EPA Form 5900-79