7610-1 Certificate of Representation

United States Environmental Protection Agency

OMB Nos. 2060-0258 and 2060-0667

Acid Rain, CSAPR, and Texas SO2 Programs

Approval Expires 03/31/2022

Certificate of Representation
See instructions and 40 CFR 72.24, 97.416, 97.516, 97.616, 97.716, 97.816, and 97.916, 97.1016, or a comparable state
regulation, as applicable. Note that the designated representative identified on this form is also the certifying official
responsible for making related submissions for the identified unit(s), under additional programs, as indicated in the
instructions.
This submission is:

STEP 1
Provide
information
for the plant

□ New

□ Revised (revised submissions must be complete; see instructions)

Plant Name

State

Plant Code

County Name

STEP 2
Enter
requested
information
for the
designated
representative

Latitude

Longitude

Name

Title

Company Name

Mailing Address

City

Phone Number

Fax Number

State

Zip Code

State

Zip Code

Email Address

STEP 3
Enter
requested
information
for the
alternate
designated
representative

Name

Title

Company Name

Mailing Address

City

Phone Number

Fax Number

Email Address

EPA Form 7610-1 (Revised 10-2020)

Certificate of Representation
Page 2 of 7

UNIT INFORMATION
STEP 4: Complete a separate page 2 for each unit located at the plant 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 details.
Applicable Program(s):

 Acid Rain

 CSAPR NO Annual
 CSAPR SO
 CSAPR NO Ozone Season Group 1  CSAPR SO
 CSAPR NO Ozone Season Group 2  Texas SO
 CSAPR NOx Ozone Season Group 3
X

2

Group 1

X

2

Group 2

X

Unit ID#

Unit Type

Additional Program(s):

X

2

Source Category

Generator ID Number
(Maximum 8
characters)

Acid Rain Nameplate
Capacity (MWe)

NAICS Code

Enter the date the unit began (or will begin) serving any generator producing electricity for sale
(including test generation) (mm/dd/yyyy):

Is this unit located in
Indian country?

Has this unit ever operated at another location?

Check One:

Check One:

Check One:










Actual Date
Projected Date

Yes
No

Yes
No

Company Name:

 Owner
 Operator

Company Name:

 Owner
 Operator

Company Name:

 Owner
 Operator

Company Name:

 Owner
 Operator

EPA Form 7610-1 (Revised 10-2020)

 GHG NSPS
 MATS
 NO SIP Call

CSAPR / Texas SO2 / Other
Nameplate Capacity (MWe)

Certificate of Representation
Page 3 of 7

STEP 5: Read the applicable 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 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 by contract, allowances and proceeds of transactions involving allowances will be deemed to
be held or distributed in accordance with the contract.
CSAPR 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 CSAPR NOX
Annual unit at the source.
I certify that I have all the necessary authority to carry out my duties and responsibilities under the CSAPR
NOX Annual Trading Program on behalf of the owners and operators of the source and of each CSAPR
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 decision or 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 CSAPR NOX
Annual unit, or where a utility or industrial customer purchases power from a CSAPR 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 CSAPR NOX
Annual unit at the source; and CSAPR NOX Annual allowances and; proceeds of transactions involving
CSAPR 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 CSAPR NOX Annual allowances by contract, CSAPR
NOX Annual allowances and proceeds of transactions involving CSAPR NOX Annual allowances will be
deemed to be held or distributed in accordance with the contract.

EPA Form 7610-1 (Revised 10-2020)

Certificate of Representation
Page 4 of 7

CSAPR NOX Ozone Season 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 CSAPR NOX
Ozone Season Group 1 unit at the source.
I certify that I have all the necessary authority to carry out my duties and responsibilities under the CSAPR
NOX Ozone Season Group 1 Trading Program on behalf of the owners and operators of the source and of
each CSAPR NOX Ozone Season 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 decision or 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 CSAPR NOX
Ozone Season Group 1 unit, or where a utility or industrial customer purchases power from a CSAPR NOX
Ozone Season 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 CSAPR NOX Ozone Season Group 1 unit at the source; and CSAPR NOX Ozone
Season Group 1 allowances and proceeds of transactions involving CSAPR NOX Ozone Season 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 CSAPR NOX Ozone Season Group 1 allowances by contract, CSAPR NOX Ozone
Season Group 1 allowances and proceeds of transactions involving CSAPR NOX Ozone Season Group 1
allowances will be deemed to be held or distributed in accordance with the contract.
CSAPR NOX Ozone Season 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 CSAPR NOX
Ozone Season Group 2 unit at the source.
I certify that I have all the necessary authority to carry out my duties and responsibilities under the CSAPR
NOX Ozone Season Group 2 Trading Program on behalf of the owners and operators of the source and of
each CSAPR NOX Ozone Season 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 decision or 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 CSAPR NOX
Ozone Season Group 2 unit, or where a utility or industrial customer purchases power from a CSAPR NOX
Ozone Season 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 CSAPR NOX Ozone Season Group 2 unit at the source; and CSAPR NOX Ozone
Season Group 2 allowances and proceeds of transactions involving CSAPR NOX Ozone Season 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 CSAPR NOX Ozone Season Group 2 allowances by contract, CSAPR NOX Ozone
Season Group 2 allowances and proceeds of transactions involving CSAPR NOX Ozone Season Group 2
allowances will be deemed to be held or distributed in accordance with the contract.

EPA Form 7610-1 (Revised 10-2020)

CSAPR NOX Ozone Season Group 3 Trading Program

Certificate of Representation
Page 5 of 7

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 CSAPR
NOX Ozone Season Group 3 unit at the source.
I certify that I have all the necessary authority to carry out my duties and responsibilities under the CSAPR
NOX Ozone Season Group 3 Trading Program on behalf of the owners and operators of the source and of
each CSAPR NOX Ozone Season Group 3 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 decision or 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 CSAPR
NOX Ozone Season Group 3 unit, or where a utility or industrial customer purchases power from a CSAPR
NOX Ozone Season Group 3 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 CSAPR NOX Ozone Season Group 3 unit at the source; and CSAPR NOX Ozone
Season Group 3 allowances and proceeds of transactions involving CSAPR NOX Ozone Season Group 3
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 CSAPR NOX Ozone Season Group 3 allowances by contract, CSAPR NOX Ozone
Season Group 3 allowances and proceeds of transactions involving CSAPR NOX Ozone Season Group 3
allowances will be deemed to be held or distributed in accordance with the contract.
CSAPR SO2 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 CSAPR 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 CSAPR
SO2 Group 1 Trading Program on behalf of the owners and operators of the source and of each CSAPR
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 decision or 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 CSAPR SO2
Group 1 unit, or where a utility or industrial customer purchases power from a CSAPR 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 CSAPR
SO2 Group 1 unit at the source; and CSAPR SO2 Group 1 allowances and proceeds of transactions
involving CSAPR 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 CSAPR SO2 Group 1 allowances by contract,
CSAPR SO2 Group 1 allowances and proceeds of transactions involving CSAPR SO2 Group 1 allowances
will be deemed to be held or distributed in accordance with the contract.

EPA Form 7610-1 (Revised 10-2020)

Certificate of Representation
Page 6 of 7

CSAPR SO2 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 CSAPR 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 CSAPR
SO2 Group 2 Trading Program on behalf of the owners and operators of the source and of each CSAPR
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 decision or 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 CSAPR SO2
Group 2 unit, or where a utility or industrial customer purchases power from a CSAPR 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 CSAPR
SO2 Group 2 unit at the source; and CSAPR SO2 Group 2 allowances and proceeds of transactions
involving CSAPR 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 CSAPR SO2 Group 2 allowances by contract,
CSAPR SO2 Group 2 allowances and proceeds of transactions involving CSAPR SO2 Group 2 allowances
will be deemed to be held or distributed in accordance with the contract.
Texas SO2 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 Texas SO2
Trading Program unit at the source.
I certify that I have all the necessary authority to carry out my duties and responsibilities under the Texas
SO2 Trading Program on behalf of the owners and operators of the source and of each Texas SO2 Trading
Program 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 decision or 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 Texas SO2
Trading Program unit, or where a utility or industrial customer purchases power from a Texas SO2 Trading
Program 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 Texas SO2 Trading Program unit at the source; and Texas SO2 Trading Program allowances and
proceeds of transactions involving Texas SO2 Trading Program 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 Texas
SO2 Trading Program allowances by contract, Texas SO2 Trading Program allowances and proceeds of
transactions involving Texas SO2 Trading Program allowances will be deemed to be held or distributed in
accordance with the contract.

Certificate of Representation
Page 7 of 7

EPA Form 7610-1 (Revised 10-2020)

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 10-2020)

Instructions for the Certificate of Representation
NOTE: The Certificate of Representation information can be submitted online through the CAMD Business
System (CBS), which can be accessed at https://camd.epa.gov/CBS/login/auth. See the Certificate of
Representation section of the Help File in CBS for assistance. If you have questions about CBS, send an
email to [email protected].
You must have a username and password to access CBS. You can obtain a username and password if:
(1) you are currently listed in the CAMD database as a designated representative or an agent for a
designated representative, AND (2) CAMD has received and processed a hard copy of the Electronic
Signature Agreement at https://www.epa.gov/airmarkets/electronic-signature-agreement-form. Once a
person meets these criteria, he/she should send an email to [email protected] to obtain a username
and password.
If you have questions about the Certificate of Representation, please send an email to
[email protected].
Please type or print. Submit a separate page 2 for each unit at the plant (source) subject to the Acid Rain
Program (ARP), a Cross-State Air Pollution Rule (CSAPR) trading program, or the Texas SO2 Trading
Program (TXSO2). Include units for which a Retired Unit Exemption notice has been submitted. Indicate
the page order and total number of pages (e.g., 1 of 4, 2 of 4, etc.) 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.
Note that because all emissions and monitoring plan data submitted (or resubmitted) through to EPA’s
Emissions Collection and Monitoring Plan System (ECMPS) for a unit for a given time period must be
contained in one internally consistent datafile, the designated representative identified on this form is also
the certifying official responsible for making submissions concerning the identified unit(s) where required
by additional programs, including the Greenhouse Gas New Source Performance Standards program under40
CFR part 60, subpart TTTT (NSPS4T), the Mercury and Air Toxics Standards program under 40 CFR part
63, subpart UUUUU (MATS), and state programs implementing the NOX SIP Call under 40 CFR 51.121
(SIPNOX).
STEP 1
(i)
A plant code is a number assigned by the Department of Energy’s (DOE) Energy Information
Administration (EIA) to plants that generate electricity. For older plants, "plant code" is synonymous
with "ORISPL" and "facility" codes. If the plant 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 at [email protected]. For plants that do not produce electricity, use the plant identifier assigned by EPA
(beginning with "88"). If the plant does not produce electricity and has not been assigned a plant
identifier, please send an email to [email protected].
(ii)

Enter the latitude and longitude representing the location of the plant. 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)
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). Enter the associated company name and address of the representative as it should appear on
all correspondence. 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.
8

There may be only one designated representative and one alternate designated representative for a plant.
STEP 4
(i)
Complete one page for each unit subject to the ARP, CSAPR, or TXSO2 programs, and indicate the
program(s) that the unit is subject to. Also indicate if the unit is subject to the MATS, NSPS4T, and/or
SIPNOX programs. Identify each unit at the plant 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
combustion turbine

BFB

Bubbling fluidized
bed boiler

PFB

Pressurized fluidized CT
bed boiler

Simple cycle
combustion turbine

C

Cyclone boiler

S

Stoker boiler

CB

Cell burner boiler

T

Tangentially-fired
boiler

CFB

Circulating fluidized
bed boiler

WBF

Wet bottom wall-fired Other
boiler

DB

Dry bottom wall-fired
boiler

WBT

Wet bottom turbofired boiler

ICE

Internal combustion
engine

DTF

Dry bottom turbofired boiler

WVF

Wet bottom
vertically-fired boiler

KLN

Cement kiln

DVF

Dry bottom verticallyfired boiler

PRH

Process heater

IGC

Integrated gasification
combined cycle

If there is uncertainty about how a unit should be characterized, please send an email to
[email protected].

(iii)

(iv)

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, please send an email to [email protected].
•

Electricity generation

•

Useful thermal energy production (i.e., production of process heat and/or steam for uses other
than electricity production)

•

Cogeneration (i.e., both electricity generation and useful thermal energy production through the
sequential use of energy)

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
https://www.census.gov/eos/www/naics for guidance on how to determine the proper NAICS code
for the unit.
9

(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 produces electricity for sale. If you have questions regarding this portion of the form,
please send an email to [email protected].

(vi)

For a unit that, as of the date of submission of this form, serves one or more generators (whether or
not the generator produces electricity for sale), enter the generator ID number(s) and the nameplate
capacity (in MWe, rounded to the nearest tenth) of each generator served by the unit. A unit serves
a generator if the unit 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.
A nameplate capacity should be entered in the “Acid Rain” column for each generator served by a
unit subject to the ARP, and a nameplate capacity should be entered in the “CSAPR / Texas SO2 /
Other” column for each generator served by a unit subject to any of the other programs indicated on
the form (including units that are also subject to the ARP). The nameplate capacity entered in the
“Acid Rain” column where a unit is listed in the National Allowance Database (NADB) should be the
nameplate capacity as shown in the NADB. The nameplate capacity entered in the “Acid Rain”
column where a unit is not listed in the NADB, and the nameplate capacity entered in the “CSAPR /
Texas SO2 / Other” column where a unit is subject to any programs other than the ARP, generally
should be the higher of (i) the nameplate capacity as of the generator’s initial installation or (ii) the
nameplate capacity following physical changes that result in an increase in the maximum electrical
generating output that the generator can produce on a steady-state basis when not restricted by
seasonal or other deratings. To the extent consistent with the preceding sentences, use the
nameplate capacity reported to EIA for each generator on Form EIA-860. Enter "NA" if, as of the date
of submission of this form, the unit does not serve a generator.
For the full definitions of "nameplate capacity", see 40 CFR 72.2, 97.402, 97.502, 97.602, 97.702,
97.802, 97.902, and 97.1002 as applicable. The NADB is available at
https://www.epa.gov/airmarkets/clean-air-markets-allowance-markets#Allocated. If you have
questions regarding nameplate capacity or the NADB, please send an email to
[email protected].
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. See the Certificate of Representation section of the Help File found at the top right of any
screen in CBS, including the homepage, for assistance.

(vii)

Indicate whether or not the unit is located in Indian country. “Indian country” generally includes all
lands within any federal Indian reservation, all dependent Indian communities, and all Indian
allotments for which the Indian titles have not been extinguished. For the full definition of “Indian
country”, see 18 U.S.C. § 1151.

(viii) When identifying a unit at a plant for the first time, indicate whether or not the unit ever operated at
another location. If the answer is “yes”, EPA will contact the owners/operator for more information.
STEP 5
Read the applicable certification statements, sign, and date.
10

Mail the completed, signed form to one of the following addresses (note the different zip codes):
For Regular or Certified Mail:

For Overnight Mail:

U.S. Environmental Protection Agency
CAMD – Market Operations Branch
Attention: Designated Representative
1200 Pennsylvania Avenue, NW
Mail Code 6204M
Washington, DC 20460

U.S. Environmental Protection Agency
CAMD – Market Operations Branch
Attention: Designated Representative
1200 Pennsylvania Avenue, NW
4th Floor, Room # 4153C
Washington, DC 20004
(202) 564-8717

Submit this form prior to making any other submissions under the ARP, CSAPR, or TXSO2
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. See the Certificate of Representation section of the Help
File in CBS for assistance.
Paperwork Burden Estimate
This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et
seq. (OMB Control Nos. 2060-0258 and 2060-0667). Responses to this collection of information are
mandatory (40 CFR 72.24, 97.416, 97.516, 97.616, 97.716, 97.816, 97.916 and 97.1016). 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. The public reporting and recordkeeping burden for this
collection of information is estimated to be 15 hours per response annually. 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 to the Regulatory Support Division Director, U.S. Environmental
Protection Agency (2821T), 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.

11