63.6016(k) Notification of Compliance and §63.6017(g) Semiannual Compliance Report (Spreadsheet Template) |
63.6016(k) and 63.6017(g) |
Final ICR Draft |
8/28/2024 |
OMB Control Number: 2060-0449 Form 5900-659 |
For further Paperwork Reduction Act information see: https://www.epa.gov/electronic-reporting-air-emissions/paperwork-reduction-act-pra-cedri-and-ert |
40 CFR Part 63, Subpart XXXX National Emission Standards for Hazardous Air Pollutants: Rubber Tire Manufacturing - §63.6016(k) Notification of Compliance Status and §63.6017(g) Semiannual Compliance Report Spreadsheet Template |
Welcome and Instructions |
Purpose: |
This spreadsheet template was designed by the U.S. EPA to facilitate the Notification of Compliance Status and Compliance reporting for facilities subject to 40 CFR part 63, subpart XXXX. The Notification of Compliance Status (NOCS) is a one time notification that is required for new or reconstructed sources by §63.6016(k) no later than 30 calendar days following the end of the initial 12 month compliance period. The compliance report is a report that is required for existing sources by §63.6017(g) and is due every six months, unless the facility qualifies for annual reporting (§63.6017(f)). The EPA's Compliance and Emissions Data Reporting (CEDRI) is accessible through the EPA's Central Data Exchange (https://cdx.epa.gov) |
Electronic reporting: |
Electronic submission of Compliance reports through CEDRI is required under §63.6017. |
A completed spreadsheet template should be uploaded to CEDRI to fulfill the electronic reporting requirements under §63.6016 and §63.6017. |
Do not submit information you claim as confidential business information (CBI) to EPA via CEDRI. EPA will make all the information submitted through this form via CEDRI available to the public without further notice to you. Anything submitted using CEDRI cannot later be claimed to be CBI. Furthermore, under CAA section 114(c) emissions data is not entitled to confidential treatment and requires EPA to make emissions data available to the public. Thus, emissions data will not be protected as CBI and will be made publicly available. Although we do not expect persons to assert a claim of CBI, if persons wish to assert a CBI claim, you must submit the report via CEDRI with the CBI omitted and mail a complete report, including any information claimed to be CBI, to EPA on a compact disc, flash drive, or other commonly used electronic storage media via U.S. postal service. You must mark the outside of the digital storage media as CBI and then identify electronically within the digital storage media the specific information that is claimed as CBI. Mail the media to the address in the referencing federal regulation. If no address is specified, mail the media to: U.S. EPA/OAQPS/CORE CBI Office Attention: Group Leader, Measurement Policy Group MD C404-02 4930 Old Page Rd Durham, North Carolina 27703 |
IMPORTANT: The spreadsheet must be uploaded into CEDRI as a single ZIP file, which must include this Excel workbook and any related attachments that were referenced in the workbook (i.e., additional information file found in the "Company_Information" worksheet). Note: If you are uploading file attachments for your report, the uploaded files may be in any format (e.g., zip, docx, PDF). If you would like to include an Excel file(s) as an attachment, you must first zip the excel file(s) into a separate ZIP file and include within the master ZIP file that will be uploaded into CEDRI. Once all data have been entered into the worksheets, combine this completed Excel workbook and all attachment files (including any ZIP file containing separate excel file(s), if applicable) into a single ZIP file for upload to CEDRI. |
Template Navigation and Worksheets to Complete: |
Gray worksheets: The gray worksheets labeled Company_Information and Compliance_ Options contain general information that is common to both the Notification of Compliance Status and the Compliance Report and should be completed first. After completing the gray worksheets, the spreadsheet may be saved as a site specific template to use in subsequent reports to limit subsequent data entry. Selecting "No" or "Yes" in the "Is this report a Notification of Compliance Status (NOCS)?" selection (found on the Company_Information worksheet) will hide or make visible the worksheets associated with the NOCS. The information in the gray worksheet varies very little from one reporting period to the next. NOTE: Some dropdowns on a given worksheet are dependent on data from a preceding column, so it may look like the dropdown is empty at first glance. |
Orange worksheets: The orange worksheets (NoticeOfComplianceStatus, NOCS_TireProduction, NOCS_TireCordProd, NOCS_PunctureSealantApp, and NOCS_Certification) are required if the submission is a Notification of Compliance Status. These worksheets will be hidden if "No" is selected in column P in the Company Information worksheet as the answer to "Is this report a Notification of Compliance Status (NOCS)?" question. The first three or four columns in each NOCS worksheet will be prefilled based on information entered in the 'Compliance_Options' worksheet. |
Green worksheets: In addition to the gray worksheets, complete the green worksheet(s) (Compliance Rpt - Tire Prod, Compliance Rpt - Tire Cord, Compliance Rpt - Puncture Seal, and Compliance Rpt - Deviations), that represents the actual compliance option used for each reporting period. The first three columns in each Compliance Rpt worksheet will be prefilled based on information entered in the 'Compliance_Options' worksheet. The Compliance Rpt - Certification worksheet must be completed for every compliance report. The NOCS Certification worksheet must be completed for the one time NOCS. |
Within the worksheets, examples are provided (or will be provided in Final template) and example rows are colored light red (rows 14 through 23), and the XML tags (row 13, hidden)) are colored green. These rows are locked and cannot be used for data entry. |
Certification: Complete the NOCS_Certification worksheet to complete the NOCS certification statement in accordance with §63.9(h)(2)(i)(G). Complete the Compliance Rpt - Certification worksheet to complete the certification statements required by §63.6017(c)(5), (6), and (8). |
40 CFR Part 63, Subpart XXXX National Emission Standards for Hazardous Air Pollutants: Rubber Tire Manufacturing - §63.6016(k) Notification of Compliance Status and §63.6017(g) Semiannual Compliance Report Spreadsheet Template | |||||||||||||||
Note: If submitting NOCS for any Facility listed in the table below, scroll to column Q and select Yes. New NOCS specfic worksheets will display. | |||||||||||||||
SITE INFORMATION | REPORTING PERIOD | ADDITIONAL INFORMATION | |||||||||||||
Company Record No. (Field value will automatically generate when Company Name entered in Column C.) |
Company Name (§63.6017(c)(1)) |
Address (§63.6017(c)(1)) |
Address 2 | City (§63.6017(c)(1)) |
County | State Abbreviation (§63.6017(c)(1)) |
Zip Code (§63.6017(c)(1)) |
Responsible Agency Facility ID (State Facility Identifier) |
Is this an Existing or New or Reconstructed Effective Source (Select from dropdown) |
Date of Report (§63.6017(c)(3)) |
Beginning Date of Reporting Period (§63.6017(c)(3)) |
Ending Date of Reporting Period (§63.6017(c)(3)) | Please enter any additional information. | Enter associated file name reference. | Is this report a Notification of Compliance Status (NOCS)? (Select from dropdown) |
RecordId | CompanyName | AddressLine1 | AddressLine2 | CityName | CountyName | StateName | ZIPCode | StateFacID | EffectiveSource | ReportDate | PeriodStartDate | PeriodEndDate | AddInfo | AddFile | NocsFlag |
e.g.: 1 | e.g.: EPA Tire & Rubber Co | e.g.: 123 Main Street | e.g.: Suite 100 | e.g.: Brooklyn | e.g.: Kings | e.g.: NY | e.g.: 11221 | e.g.: 9145555555 | e.g.: New or Reconstructed Source | e.g.: 7/2/2017 | e.g.: 1/1/2017 | e.g.: 6/30/2017 | e.g.: Provide any additional information here. | e.g.: addlinfo.zip | e.g.:Yes |
1 | CompanyName | ||||||||||||||
40 CFR Part 63, Subpart XXXX National Emission Standards for Hazardous Air Pollutants: Rubber Tire Manufacturing - | |||||
63.6016(k) Notification of Compliance and §63.6017(g) Semiannual Compliance Report (Spreadsheet Template) | |||||
Note: Company Record No. selections appear once Company(s) are added to Company_Information worksheet. Fill out table moving left to right, as dropdowns are dependent on previous selections. | |||||
COMPLIANCE OPTIONS | |||||
Company Record No. (Select from dropdown) |
Rubber Tire Manufacturing Affected Source or Facility as stated in §63.6017(c)(7) if applicable. (§63.9(h)) |
Rubber Tire Manufacturing Subcategory (Select from dropdown) |
Identification of the Compliance Option (Appendices - Table 1, 2, 3, 4, 15 or 16 To Subpart XXXX of Part 63) (Select from dropdown) |
Identification of the Compliance Alternative (Appendices - Table 1, 2, 3, 4, 15 or 16 To Subpart XXXX of Part 63) (Select from dropdown) |
Select corresponding emissions or operating limit (Appendices - Table 1, 2, 3, 4, 15 or 16 To Subpart XXXX of Part 63) (Select from dropdown) |
RecordId | OperationName | Subcategory | ComplianceOptions | ComplianceOptionAlt | EmissionLimit |
e.g.: 2 | e.g.: EPA Tire & Rubber Co | e.g.: Tire Production | e.g.: Option 1—HAP constituent option | e.g.: Purchase alternative | e.g.: a. Emissions of each HAP in Table 16 to this subpart must not exceed 1,000 grams HAP per megagram (2 pounds per ton) of total cements and solvents used at the tire production affected source, and b. Emissions of each HAP not in Table 16 to this subpart must not exceed 10,000 grams HAP per megagram (20 pounds per ton) of total cements and solvents used at the tire production affected source. |
40 CFR Part 63, Subpart XXXX National Emission Standards for Hazardous Air Pollutants: Rubber Tire Manufacturing - | ||||||
Note: Columns B through D will be autofilled based on responses provided in the Compliance_Options worksheet. | ||||||
63.6017(g) Semiannual Compliance Report | ||||||
Company Record No. (Autofilled) |
Rubber Tire Manufacturing Affected Source or Facility as stated in §63.6017(c)(7). (Autofilled) |
Rubber Tire Manufacturing Subcategory (Autofilled) |
For each tire production affected source, provide the emission limit option in §63.5984 that you have chosen to meet (§63.6017(c)(7)) (Autofilled) |
For each tire production affected source, provide the compliance alternative in §63.5985 that you have chosen to meet (§63.6017(c)(7)) (Autofilled) |
For each tire production affected source complying with the purchase compliance alternative in §63.5985(a), not listed in NOCS in §63.6016(g), provide updated list of all cements and solvents used, as purchased at affected source (§63.6017(c)(8)) |
Certify that each cement or solvent, as purchased, used at the affected source during the reporting period met the HAP constituent limits (option 1) in Table 1 to this subpart. (§63.6017(c)(8)) |
RecordId | OperationName | Subcategory | EmissionLimitOption | ComplianceAlternative | CementsAndSolventsUsed | HAPConstituentLimits |
e.g.: 1 | e.g.: CuringPress1 | e.g.: Tire Production | e.g.: HAP constituent option | e.g.: Purchase alternative | e.g.: cementX | e.g.: Yes |
40 CFR Part 63, Subpart XXXX National Emission Standards for Hazardous Air Pollutants: Rubber Tire Manufacturing - | ||||
Note: Columns B through D will be autofilled based on responses provided in the Compliance_Options worksheet. | ||||
63.6017(g) Semiannual Compliance Report | ||||
Company Record No. (Autofilled) |
Name of Rubber Tire Manufacturing Affected Source (§63.9(h)) (Autofilled) |
Rubber Tire Manufacturing Subcategory (Autofilled) |
For each tire cord production affected source, provide the emission limit option in §63.5986 that you have chosen to meet (§63.6017(c)(9)) (Autofilled) |
For each tire cord production affected source, provide the compliance alternative in §63.5987 that you have chosen to meet (§63.6017(c)(9)) (Autofilled) |
RecordId | OperationName | Subcategory | EmissionLimitOption | ComplianceAlternative |
e.g.: 1 | e.g.: Extruder1 | e.g.: Tire Cord Production | e.g.: Option 1.a (production-based option)—Existing | e.g.: Monthly average alternative, using an add-on control device |
40 CFR Part 63, Subpart XXXX National Emission Standards for Hazardous Air Pollutants: Rubber Tire Manufacturing - | ||||
Note: Columns B through D will be autofilled based on responses provided in the Compliance_Options worksheet. | ||||
63.6017(g) Semiannual Compliance Report | ||||
Company Record No. (Autofilled) |
Name of Rubber Tire Manufacturing Affected Source (§63.9(h)) (Autofilled) |
Rubber Tire Manufacturing Subcategory (Autofilled) |
For each puncture sealant application affected source, provide the emission limit option in §63.5988 that you have chosen to meet (§63.6017(c)(10)) (Autofilled) |
For each puncture sealant application affected source, provide the compliance alternative in §63.5989 that you have chosen to meet (§63.6017(c)(10)) (Autofilled) |
RecordId | OperationName | Subcategory | EmissionLimitOption | ComplianceAlternative |
e.g.: 1 | e.g.: tire 3 | e.g.: Puncture Sealant Application | e.g.: Option 1.a (percent reduction option)—Existing | e.g.: Overall control efficiency alternative |
40 CFR Part 63, Subpart XXXX National Emission Standards for Hazardous Air Pollutants: Rubber Tire Manufacturing - | ||
Note: Columns B through C will be autofilled based on responses provided in the Compliance_Options worksheet. | ||
63.6017(g) Semiannual Compliance Report | ||
Company Record No. (Autofilled) |
Name of Rubber Tire Manufacturing Affected Source (§63.9(h)) (Autofilled) |
For each rubber processing affected source, provide the emission limit option in §63.6010(b) that you have chosen to meet - either metal HAP emission limit or PM emission limit (§63.6017(c)(11)) (Autofilled) |
RecordId | OperationName | EmissionLimitOption |
e.g.: 1 | e.g.: tire 3 | e.g.: Option 1.a (percent reduction option)—Existing |
40 CFR Part 63, Subpart XXXX National Emission Standards for Hazardous Air Pollutants: Rubber Tire Manufacturing - | ||
Note: Columns B through C will be autofilled based on responses provided in the Compliance_Options worksheet. | ||
63.6017(k) 15 -day Rolling Average Report | ||
Company Record No. (Autofilled) |
Name of Rubber Tire Manufacturing Affected Source (§63.9(h)) (Autofilled) |
For each rubber processing affected source, provide the THC 15-day rolling average values (g/Mg of Rubber Processed) (§63.6017(k)) |
RecordId | OperationName | 15DayRollingAverage |
e.g.: 1 | e.g.: tire 3 | e.g.: 0.20 |
40 CFR Part 63, Subpart XXXX National Emission Standards for Hazardous Air Pollutants: Rubber Tire Manufacturing - | |||||||||||
Note: Start by using dropdown in Column E to select affected source. Columns B through D will be autofilled based on responses provided in the Compliance_Options worksheet. | |||||||||||
63.6017(g) Semiannual Compliance Report - Deviations from an emission limitation (emission limit or operating limit) | |||||||||||
Company Record No. (Autofilled) |
Name of Rubber Tire Manufacturing Affected Source (§63.9(h)) (Autofilled) |
Rubber Tire Manufacturing Subcategory (Autofilled) |
Company Record No., Name of Rubber Tire Manufacturing Affected Source, and Subcategory (§63.9(h)) (Select from dropdown) |
Cement or solvent that deviated from the emission limit (§63.6017(d)) |
Date of each deviation (§63.6017(d)(1)) |
Time of each deviation (§63.6017(d)(1)) |
Duration (hours) of each deviation (§63.6017(d)(1)) |
Estimate of the Quantity Emitted Over Emission Limit (§63.6017(d)(2)) |
Description of the Method Used to Estimate the Emissions. (§63.6017(d)(2)) |
Cause of deviation (§63.6017(d)(2)) |
Corrective Action(s) Taken (§63.6017(d)(3)) |
RecordId | OperationName | Subcategory | RecordSourceSubcategory | CoatingName | UseStartDate | UseStartTime | UseDuration | EmissionsQuantity | EstimationMethod | DeviationCause | CorrectiveAction |
e.g.: 1 | e.g.: CuringPress1 | e.g.: Tire Production | e.g.: 1 CuringPress1 Tire Production | e.g.: solventx | e.g.: 2/1/2017 | e.g.: 13:05 | e.g.: 36.25 | e.g.: 2.5 | e.g.: Mass balance | e.g.: leak | e.g.: Ordered new materials |
40 CFR Part 63, Subpart XXXX National Emission Standards for Hazardous Air Pollutants: Rubber Tire Manufacturing - §63.6017(g) Semiannual Compliance Report Spreadsheet Template | |||
Complete this form when you have completed the semiannual compliance report. | |||
63.6017(g) Semiannual Compliance Report | |||
Company Record No. (Autofilled) |
There were no deviations from any emission limitations (emission limit or operating limit) during the reporting period. (§63.6017(c)(5)) (Select from dropdown) |
There were no periods during which the operating parameter monitoring systems or CPMS were out-of-control during the reporting period. (§63.6017(c)(6)) (Select from dropdown) |
For each tire production affected source complying with the purchase compliance alternative in §63.5985(a), I certify that each cement and solvent, as purchased, that was used at the affected source during the reporting period met the HAP constituent limits (Option 1) in Table 1 to this subpart. (§63.6017(c)(8)) (Select from dropdown) |
RecordId | PeriodDeviationFlag | CPMSAddonComplianceFlag | HAPConstituentFlag |
e.g.: 1 | e.g.: No | e.g.: Yes | e.g.: Yes |
1 | |||
40 CFR Part 63, Subpart XXXX National Emission Standards for Hazardous Air Pollutants: Rubber Tire Manufacturing - | ||
§63.6017(g) Semiannual Compliance Report Spreadsheet Template | ||
Revision Number | Date | Revisions |
1.00 | 6/5/2020 | Finalized Release Version |
1.02 | 6/16/2020 | Unlocked Column F on NOCS_PunctureSealantApp, Columns F-M on Compliance Rpt - Deviations, and entry cells on Compliance Rpt - Certification tabs |
1.03 | 4/9/2024 | Updated Welcome tab |
Final ICR Draft | 8/28/2024 | Update regulatory citations throughout to reflect revised regulatory text, updated formatting, removed "*", added "e.g.:" to all blank example rows; Revisions: Header added; Compliance_Options: updated examples, updated dropdown to reflect new compliance options, updated header to reflect Tables 15 and 16; NoticeOfComplianceStatus: updated header to reflect Tables 15 and 16; Add tab Compliance Rpt - metHAP or PM; |
File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
File Modified | 0000-00-00 |
File Created | 0000-00-00 |