Owner Operator Response Form with Facility Information 20240403 v01

Enforcement and
Compliance History Online

Login

Con tac t Us

Home > Owner/Operator Res pon se Form

Owner/Operator Response Form
This form all ows owners/operators to respond to the n ot ificatio n of a methane super em it ter event at the ir
wellsite or facility .
- Collapse All

+ Expand All

f>Help

-

Point of Contact Information

e
Email•

Submit Form
Clear Form

Point of Contact Name•

Phone

Alter nate Contacts (email)

-

Notification Information

e

Notif icati on Repor t ID•

Notification Coordinates
L atitude: 35.1789

Longitude: •147. 2569

Are you the owner or operator or responsible official (where applicable)
of an oil and natur al gas facility (e.g., individual well site, centralize d
production facility, natural gas processing plant, or compressor station)
withi n 50 meters from the latitude and longitude provided in the EPA
notification?•

@

Yes

O No

Facility In formation
If the EPA ID# or API Well ID# in the notification was incorre ct, please input the cor rect ID in the field be low.
EPA ID#
OR
API Well ID#

Facility Name•

Address/City/State/Zip•

-

Damonstrabla Error

Do you assert a demonstrable
error in the notification?•

e

0 Yes O No

Evidence

Drag fil e here or choose from folder

Statement of Demonstrable Error
(required if asserting a
demonstrable erro r)

-

Applicability and Identification
I s there an affected facility or
associated equipment subject to
regulation under NSPS 0000,
NSPS 0000a, NSPS 0000b,
and/or a State or Federal Plan
implementing OOOOc at this oil
and gas facility?•
Did you identify the source of the
super emitter event?•

e

O Yes O No

O Yes O No
-

Evaluation of Source

e
What was the source of the
emission?•
I s the source subject to regulation

O 0000 0 0000a O 0000b O 0000c O None

under NSPS 0000, NSPS 0000a,
NSPS 0000b, and/or a State,
Tribal or Federal Plan
implementing OOOOc? •
Pl ease identify by citation the
applicable regulation(s) within
each applicable subpart and/or
plan (Write “Not Applicable” if
checking "None" above.) *

-

Status and Response Plan
I s this emission event ongoing?•

0 Yes O No

What day did the emission event
end? If the date is unknown, an
estim ate should be provided.
(required if no to previous
question)
I s the above date a n estimate?
(requi re d if the emission Is ended)
What time?

mm/dd/yyyy

0 Yes O No

I

What time zone?

e

Targeted End Date (required if
emission is ongoing)

No Restrictions

mm/dd/yyyy

Provide a short narrative of your
plan to end the super-emitter
event•

Response Narrative Attachme nt(s)

Drag fil e here or choose from folder

-

Search for Source

Did you conduct the appl icable
investigations list ed in (d)(2)(i)•
(v)?

0 (i) Review any maintenance activities or process activities
0 (ii) Review all monitoring data from control devices
0 (iii) Review the results of a fugitive emissions survey or

e

periodic screening event

0 (iv) Review continuous monitoring data

0 (v) Screen the entire oil and n atural gas facility with OGI,
Method 21 or an alternative test method

Alter native Test Method (s)
approved per§ 60.5398b(d), such
as MATM-XXXX
mm/dd/yyyy

What day was this investigation?•

What time?

I

What time zone?

No Restrictions

0 I certify that all applicable investi gations specified in paragraph (d)(2)(i) through (v) of this

section have been conducted for all affected facilities and associated equipment subject to this
subpart that are at this oil and natural gas facility.•

-

Optional Additions
Do you wish to self report a data element? Self-reported data will be
displayed alongs ide data from the Third Party Notifier.

I
I
I+

e

0 Yes

Data Elemen ts
F acility Name

Quantification

Add Data Element

I

If there are additional comments
or documentation you wish to
provide, please do s o below .

�-----------------------------------------------·······································�'
'
''
'

''
'

Attachment(s)

Drag fil e here or choose from folder

------------------------------------------------··········

''
·····························�'

-

Attestation
I certify that the information provi ded in this report regardin g the specified super-emitter

e

event was prepared under my direction or supervision. I further cert ify that the investigations
were conducted, and this report was prepared pursuant to the requirements of §G0.5371b( d) and
(e). Based on my professional knowledge and experience, and inquiry of personnel involved in
the assessment, the certification submitted herein is true, accurate, and complete. I am aware
that knowingly fal se statements may be punishable by fine or imprisonment.
D igital Signature

�-------------------------------· ······························ ·································�'

''
''

''
'

Drag fil e here or choose from folder
''
............................................................................................... �'

4' Top of Page