5900-390 Part 1: Submit 30 Days Prior to Beginning Construction -

EPA Form No. 5900-390
EPA ICR No. 1230.27
OMB Control No. 2060-0003
Approval expires 4/30/2017

United States Environmental Protection Agency
https://www.epa.gov/tribal-air/tribal-minor-new-source-review
January 4, 2017

Part 1: Submit 30 Days Prior to Beginning Construction -- General Facility Information
FEDERAL IMPLEMENTATION PLAN FOR TRUE MINOR SOURCES IN INDIAN
COUNTRY IN THE OIL AND NATURAL GAS PRODUCTION AND NATURAL
GAS PROCESSING SEGMENTS OF THE OIL AND NATURAL GAS SECTOR
Registration for New True Minor Oil and Natural Gas Sources and Minor
Modifications at Existing True Minor Oil and Natural Gas Sources
Please submit information to:

[Reviewing Authority
Address
Phone]
A. GENERAL SOURCE INFORMATION (See Instructions Below)
1. Company Name
2. Source Name
3. Type of Oil and Natural Gas Operation

4. New Minor Source?

Yes

5. Minor Source Modification?
6. NAICS Code

No
Yes

No

7. SIC Code

8. U.S. Well ID(s) or API Number(s) [if applicable]
9. Area of Indian Country

10. County

11a. Latitude

11b. Longitude

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EPA Form No. 5900-390
EPA ICR No. 1230.27
OMB Control No. 2060-0003
Approval expires 4/30/2017

B. CONTACT INFORMATION (See Instructions Below)
1. Owner Name

Title

Mailing Address

Email Address

Telephone Number

Facsimile Number

2. Operator Name (if different from owner)

Title

Mailing Address

Email Address

Telephone Number

Facsimile Number

3. Source Contact

Title

Mailing Address

Email Address

Telephone Number

Facsimile Number

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EPA Form No. 5900-390
EPA ICR No. 1230.27
OMB Control No. 2060-0003
Approval expires 4/30/2017

4. Compliance Contact

Title

Mailing Address

Email Address

Telephone Number

Facsimile Number

C. ATTACHMENTS
Include all of the following information as attachments to this form:
Narrative description of the operations.
Identification and description of all emission units and air pollution generating activities (with the exception of the
exempt emissions units and activities listed in §49.153(c).
Identification and description of any air pollution control equipment and compliance monitoring devices or activities
that are expected to be used at the facility.
Estimated operating schedules.
If satisfying the requirements under §49.104(a)(1), documentation that another federal agency has complied with its
requirements under the Endangered Species Act (ESA) and the National Historic Preservation Act (NHPA) when
authorizing the activities for the facility/activity covered under this registration. The appropriate documents shall clearly
show that the other federal agency had met its obligations under both the ESA and NHPA. A simple reference to a
Record of Decision or other final decision document will not be acceptable. Examples of acceptable documentation
would be a letter from the U.S. Fish and Wildlife Service field office (for ESA) or a historic preservation office (for
NHPA) stating they agree with the assessment conducted by the other federal agency for the subject project and that the
requirements of those statutes have been met. The documentation shall be submitted within the Part 1 registration.
If satisfying the requirements under §49.104(a)(2), the letter provided by the Reviewing Authority indicating satisfactory
completion of the specified screening procedures to address threatened or endangered species and historic properties.
The documentation shall be submitted under the Part 1 registration. (The procedures are contained in the following
document: “Procedures to Address Threatened or Endangered Species and Historic Properties for the Federal
Implementation Plan for True Minor Sources in Indian Country in the Oil and Natural Gas Production and Natural Gas
Processing Segments of the Oil and Natural Gas Sector,” https://www.epa.gov/tribal-air/tribal-minor-new-sourcereview).
Other.

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EPA Form No. 5900-390
EPA ICR No. 1230.27
OMB Control No. 2060-0003
Approval expires 4/30/2017

Instructions for Part 1
Please answer all questions. If the item does not apply to the source and its operations write “n/a”. If the answer is not
known write "unknown".
A. General Source Information
1. Company Name: Provide the complete company name. For corporations, include divisions or subsidiary name, if
any.
2. Source Name: Provide the source name. Please note that a source is a site, place, or location that may contain one
or more air pollution emitting units.
3. Type of Operation: Indicate the generally accepted name for the oil and natural gas production or natural gas
processing segment operation (e.g., oil and gas well site, tank battery, compressor station, natural gas
processing plant).
4. New True Minor Source: [Per Federal Indian Country Minor New Source Review Rule, 40 CFR 49.153].
5. True Minor Source Modification: [Per Federal Indian Country Minor New Source Review Rule, 40 CFR 49.153].
6. North American Industry Classification System (NAICS): The NAICS Code for your oil and natural gas source
can be found at the following link for North American Industry Classification System:
http://www.census.gov/eos/www/naics/.
7. Standard Industrial Classification Code (SIC Code): Although the new NAICS code has replaced the SIC
codes, much of the Clean Air Act permitting processes continue to use these codes. The SIC Code for your oil
and natural gas source can be found at the following link for Standard Industrial Classification Codes:
http://www.osha.gov/pls/imis/sic_manual.html.
8. U.S. Well ID or API Number: Unique well identifier as assigned by the Federal or State oil and gas regulatory
agency with primacy, using the American Petroleum Institute (API) Standard for number format (pre-2014) or the
Professional Petroleum Data Management (PPDM) Association US Well Number Standard (2014-present).
Provide IDs for all oil and natural gas production wells associated with the facility, if applicable. May not be
applicable for downstream production sources, such as compressor stations.
9. Area of Indian Country: Provide the name of the Indian reservation within which the source is operating.
10. County: Provide the County within which the source is operating.
11. Latitude & Longitude (11a. and 11b.): Provide latitude and longitude location(s) in decimal degrees, indicating
the datum used in parentheses. These are GPS (global positioning system) coordinates. This information should
be provided in decimal degrees with 6 digits to the right of the decimal point, indicating the datum used in
parentheses (i.e., NAD 27, NAD 83, WGS 84 – WGS 84 is preferred over NAD 27).
B. Contact Information
Please provide the information requested in full.
1. Owners: List the full name (last, middle initial, first) of all owners of the source.
2. Operator: Provide the name of the operator of the source if it is different from the owner(s).
3. Source Contact: The source contact must be the local contact authorized to receive requests for data and
information.
4. Compliance Contact: The compliance contact must be the local contact responsible for the source’s compliance
with this rule. If this is the same as the Source Contact please note this on the form.

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EPA Form No. 5900-390
EPA ICR No. 1230.27
OMB Control No. 2060-0003
Approval expires 4/30/2017

C. Attachments
The information requested in the attachments will enable the U.S. Environmental Protection Agency (EPA) to understand
the type of oil and natural gas source being registered.
Disclaimers:
The public reporting and recordkeeping burden for this collection of information is estimated to average 6 hours per
response. 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.
Information in these forms submitted in compliance with the final Federal Indian Country Minor New Source Review rule
may be claimed as confidential. A company may assert a claim of confidentiality for information submitted by clearly
marking that information as confidential. Such information shall be treated in accordance with EPA’s procedures for
information claimed as confidential at 40 CFR part 2, subpart B, and will only be disclosed by the means set forth in the
subpart. If no claim of confidentiality accompanies the report when it is received by EPA, it may be made public without
further notice to the company (40 CFR 2.203).

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