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              MINOR SOURCE PERMIT APPLICATION
for a
ROCK CRUSHING FACILITY
or a
SAND & GRAVEL OPERATION
FORMS & INSTRUCTIONS
AIR QUALITY DIVISION
STATE OF OKLAHOMA
DEPARTMENT OF ENVIRONMENTAL QUALITY
707 N. ROBINSON AVE., SUITE 4100
P.O. BOX 1677
OKLAHOMA CITY, OK 73101-1677
PHONE: (405) 702-4100
FAX: (405) 702-4101
REVISED AUGUST 28, 1997 Instructions Revised March 1, 2012
MINOR SOURCE APPLICATION INSTRUCTIONS ROCK CRUSHING FACILITIES SAND & GRAVEL OPERATIONS
ASSISTANCE AVAILABLE
DEQ Customer Assistance: (800) 869-1400
Air Quality Division: (405) 702-4100
INTRODUCTION
This package contains the State of Oklahoma Air Quality Permit Application for a Minor Source. Please read all the directions carefully before you fill it out. Answer all questions by checking the appropriate box or filling in a response. Original signature from a responsible official is required on Form 884. Please note that delays in processing your application may occur if an incomplete application is submitted. It is the applicant’s responsibility to submit a complete application well in advance of anticipated commencement of construction, start up dates, or the effective date of operating permit program requirements to allow sufficient time for proper application review and permit issuance.
BACKGROUND
Oklahoma operates a dual air quality permit system under Oklahoma Administrative Code (OAC) 252:100. A construction permit is to be obtained prior to the commencement of construction, installation or modification of any source which will increase the amount of air contaminant emissions by more than the de minimis levels given in OAC 252:100-7-2. After construction is completed, application for an operating permit must be submitted within 60 days after start up. If you are uncertain whether a permit is required, a request for an applicability determination may be submitted to DEQ and a written determination will be made based on the data submitted. An applicability determination can also be performed to determine whether a facility is a major or minor source.
DEFINITIONS
Criteria Pollutant: Oxides of Nitrogen (NOx), Sulfur Dioxide (SO2), Lead (Pb), Ozone (O3, i.e., regulated as non-methane hydrocarbon or NMHC as a precursor to O3), Particulate Matter less than 10 microns (PM10), Carbon Monoxide (CO).
Minor Source: A source that has the potential to emit less than 100 tons/year of a criteria pollutant, less than 10 tons/year of any single hazardous air pollutant, and less than 25 tons/year total hazardous air pollutants in the aggregate. These sources are classified as Tier I sources and follow the simplest type of application process.
Synthetic Minor Source: A source which has the potential under maximum operating conditions to emit at the Major Source level but which has a permit which restricts emissions to the minor source level. Such restrictions may include any of the following: hours of operation, emission control devices, and throughput. Applications for minor source permits are classified as either Tier I or Tier II, depending on several factors.
Major Source: A source that has the potential to emit more than 100 tons/year for criteria pollutants, 25 tons/year of hazardous air pollutants, or 10 tons/year of any single hazardous air pollutant. Additionally, a Major Source will not have permit requirements which restrict all actual criteria pollutant and hazardous air pollutant emissions to less than these levels. These sources are complex in their potential impact and are subject to the Tier II or Tier III application process.
TIER DETERMINATION
DEQ’s “Uniform Permitting” system, under OAC 252:002, categorizes applications as Tier I, II, or III, depending on their complexity and the amount of public interest. The main effect of a Tier classification is the amount of public review given the application. For Air Quality permits, Tier I basically includes minor sources and most synthetic minor sources. Tier II covers major sources, and Tier III covers only very large sources such as those requiring PSD review. This packet is designed (only) to meet the application requirements for most Rock Crushing Facilities and Sand & Gravel Operations which are minor sources or synthetic minor sources and qualify as Tier I applications. Other facilities, including those with emission units not covered in this application packet and those that need emissions modeling assistance, should contact Air Quality for information or additional forms and/or worksheets.
PERMIT FEES
Applicants must attach a check or money order (no cash will be accepted) payable to the DEQ Air Quality Division in accordance with Form 100-815, which is included in this packet.
APPLICATION MUST INCLUDE: SUBMIT 3 COPIES OF COMPLETED APPLICATON TO:
1. DEQ Form # 100-884 (General Facility Information Form) DEPARTMENT OF ENVIRONMENTAL QUALITY
2. DEQ Form # 100-110 (Emission Units information for each unit on site) AIR QUALITY DIVISION
3. DEQ Form # 100-810 (Landowner Affidavit) 707 N ROBINSON, SUITE100
4. DEQ Form # 100-815 (AQ Application Classification Fees) P.O. Box 1677
5. Appropriate fees (check payable to DEQ Air Quality Division) OKLAHOMA CITY, OK 73101-1677
6. Facility Plot Plan & Process Flow Diagram DEQ Form 100-810 Revised 7/10/02
Tier I, II, or III permit applicants must provide notice to the landowner(s). The basis for this requirement is Title 27A of the Oklahoma Statutes, Supplement 1996, § 2-14-103(9), as described in OAC 252:4-7-13 (b).
Please note that you MUST fill out and return this affidavit even if you don’t have to give any landowner notice.
A NOTICE TO THE LANDOWNER(S) IS NOT REQUIRED because: (check one)
My application does not involve any land.
My application involves only land owned by me (or applicant business).
I have a current lease given to accomplish the permitted purpose.
I have a current easement given to accomplish the permitted purpose.
OR
B NOTICE TO THE LANDOWNER(S) IS REQUIRED because the land is owned by someone other than myself or the applicant business AND I HAVE NOTIFIED the following (check one):
Landowner(s)
Lessor or Administrator or Executor of the land METHOD OF DELIVERY (check one):
Actual notice, for which I have a signed and dated receipt
Service by Sheriff or private process server, for which I have an affidavit
Service by certified mail, restricted delivery, for which I have a signed return receipt
Legal publication, for which I have an affidavit of publication from the newspaper, because the landowners could not be located through due diligence
LANDOWNER AFFIDAVIT CERTIFICATION I, as the applicant or an authorized representative of the applicant, hereby certify that I own the real property, have a current lease or easement which is given to accomplish the permitted purpose (per Option A above), or have provided legal notice to the landowner(s) (per Option B above) about the permit application for the facility described below. Company Name
Facility Name
Facility Address or Legal Description.
Responsible Official (signature)
Date Signed
Responsible Official (typed)
Title
If the landowner notice applies to your application (Option B above) you can send the following form to them as your notice:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
DEQ LANDOWNER NOTIFICATION AFFIDAVIT
NOTICE TO LANDOWNER OF FILING
Dear Landowner: (Name)
(Applicant name) has filed a permit application with the Oklahoma
Department of Environmental Quality for (Facility Name) facility.
This application involves the land owned by you located at:
Address or Legal Description:
Signed: Date: DEQ Form # 100-884 Revised July 30, 2010
AIR QUALITY PERMIT APPLICATION GENERAL FACILITY INFORMATION
APPLICATION NUMBER (AQD Use Only)
1 COMPANY INFORMATION Name
Mailing Address
City
State
Zip
2 APPLICATION TYPE
Applicability Determination
Construction Permit
Operating Permit
GP Authorization To Operate
GP Authorization To Construct GP Name:
Renewal
Modification
Relocation
PBR PBR Type:
Permit Number(s) (If Applicable)
Est. Date of Construction/Modification Start:
Operational Start-up:
Completion:
3 IS CONFIDENTIAL INFORMATION INCLUDED?
YES
NO By including confidential information, Applicant acknowledges that such information may be shared with the U.S. Environmental Protection Agency for purposes consistent with the Federal Clean Air Act, 42 U.S.C. §§ 4201 et. seq.
4 TIER CLASSIFICATION
Tier I
Tier II
Tier III
N/A – AD only FACILITY TYPE
Major
Minor
Synthetic Minor
5 FEES SUBMITTED
$ CHECK #
DATE
6 TECHNICAL CONTACT Name
Phone
Fax
Email Address
Company Name
Street Address
City
State
Zip
7 FACILITY INFORMATION Name
SIC Code(s)
NAICS Code(s)
Contact Person
Title
Phone
LEGAL DESCRIPTION Sub Section
Section
Township
Range
Physical Address or Driving Directions
City or Nearest Town
Zip
County
8 GEOGRAPHIC COORDINATES Latitude (to 5 Decimals) Longitude (to 5 Decimals) DATA SOURCE GPS DEQ Data Viewer Web Viewer (Specify):
Center of Township & Range Section or relevant subsection
Street Address (Conversion Program):
Unknown Other (Specify):
REFERENCE POINT Facility Entrance Point or First Gate of Lease Property (preferred above all other options) Center of Facility Unknown Other (Specify):
9 APPLICATION CERTIFICATION This application, including all attachments, has been submitted as required by OAC 252:100. I certify that (a) I am the Responsible Official for this company as defined in OAC 252:100-3; and (b) based on information and belief formed after reasonable inquiry, the statements and information contained in this application are true, accurate, and complete. Responsible Official (name)
Title
Responsible Official (signature)
Date
Phone
Fax
Email Address
Street Address
City
State
Zip
DEQ Form # 100-110 PAGE 1 of 2 Revised 8/28/97
EMISSION UNITS - ROCK CRUSHING & SAND FACILITIES
MINOR SOURCE EQUIPMENT DESCRIPTION
In the table below, please list all emission units, (e.g., hoppers, crushers, grinders, screens, stockpiles, organic liquid storage tanks, and other miscellaneous equipment) located at the facility. For each unit, give an unique identifier (e.g. facility numbering system or emissions inventory ID#), number of operation hours per year, the equipment installation date (actual or projected), and the date the equipment was manufactured or modified. In the last column, indicate whether the unit is a subject of the requested permit action (Construction or Operating Permit, or Modification of an existing permit).
EMISSION UNITS (Equipment) Operating Hours Manufacture or Modify Installation Date Unit Subject of this Permit Action? ID # Description Per Year Date Yes No
Please provide the following information for each piece of equipment which is subject of the requested permit action. Data submitted for construction permits should be a best estimate. The values may be modified following construction and/or subsequent testing. This information is necessary to determine the emissions. Indicate crusher type according to product size, as used in AP-42, (1/95), Section 11.19.2: primary (3 to 12 inches), secondary (1 to 4 inches), or tertiary (3/16th to 1 inch). Likewise, indicate for each screen whether it serves as a fines screen or “other.” Provide the requested information for each transfer point, including truck unloading, if applicable.
EMISSION POINTS – CRUSHERS/GRINDERS Process Rate Controls Emission Factor (lb/ton) ID# Crusher Type (TPH) Type Efficiency Controlled Uncontrolled
SCREENS Process Rate Controls Emission Factor (lb/ton) ID# Screen Type (TPH) Type Efficiency Controlled Uncontrolled
DEQ Form # 100-110 PAGE 2 of 2 Revised 8/28/97
OTHER EQUIPMENT Process Rate Controls Emission Factor (lb/ton) ID# Equipment Type (TPH) Type Efficiency Controlled Uncontrolled
STOCKPILES (Total Estimated Fugitives from Storage Piles) Stockpile Area Controls Emission Factor (lb/acre/day) ID# Stored Material (Acres) Type Efficiency Controlled Uncontrolled
MATERIAL TRANSFER POINTS Process Rate Controls Emission Factor (lb/ton) From (ID#) To (ID#) (TPH) Type Efficiency Controlled Uncontrolled
EMISSIONS DATA SOURCE
AP-42 (Jan. ’95)
Other (Specify):
CONTROL OF FUGITIVE DUST FROM VEHICLE TRAVEL Miles of Paved Facility Roads
Miles of Unpaved Facility Roads
Road Dust Suppression Practices
Water Truck
Road Oiling OCC Permit #:
Other (Specify):
Please provide the following information if organic liquid storage tanks (e.g., fuel, solvents) with capacity of 400 gallons or more are operated at the facility. Data submitted for construction permits should be a best estimate. The values may be modified following construction and/or subsequent testing. Applicants must fill out a complete table for each such tank which has a capacity of 400 gallons or more.
STORAGE TANKS Tank ID #
Construction / Modification Date
Type of Liquid Stored:
Gasoline
Diesel
Other (Specify):
Tank Capacity (gallons)
Vapor Pressure (psia)
Tank Height (ft)
Tank Diameter (ft)
Maximum Throughput (gallons/year)
Tank Color
Controls:
Submerged Fill Pipe
Vapor Recovery System
Other (Specify):
DEQ Form #100-815 Revised March 1, 2012
AIR QUALITY DIVISION CLASSIFICATION OF AQ PERMIT APPLICATIONS & APPLICATION FEES
Application Number (AQD Use Only)
Company Name
Facility Name
Mailing Address
City
State
Zip
This form is used to document both a preliminary determination of the Tier classification and any associated Application Fee.
Step 1: APPLICATION CLASSIFICATION AND TIER DETERMINATION
DEQ’s “Uniform Permitting” system, under OAC 252:004, categorizes different types of applications as Tier I, II, or III, depending on their complexity and the amount of public interest. The main effect of a Tier classification is the amount of public review given the application. For Air Quality permits, Tier I basically includes minor facilities and most synthetic minor facilities. Tier II covers major sources, and Tier III covers only very large sources such as those requiring PSD review. Additional information to make a preliminary determination of the Tier classification is provided on the next page. This determination will be verified before permit issuance.
Note that all Tier II and III applications require public notice of the application in one newspaper local to the site or facility as soon after the filing date as possible. Other public participation requirements, such as notice of draft and proposed permit, and notice of public meeting may also be required. Contact our office for more information on these requirements. TIER CLASSIFICATION
Tier I
Tier II
Tier III
N/A – AD only FACILITY TYPE
Major
Minor
Synthetic Minor Confirmed/Corrected by: (AQD Use Only)
Step 2: APPLICATION TYPE & FEE
Application fee may be determined according to the following schedule. The emissions level is based on the single criteria pollutant with the highest emissions rate. Fees are subject to change – please refer to OAC 252:100-7-3 or 252:100-8-1.7 for the latest fee schedule. MAJOR SOURCE Fee MINOR OR SYNTHETIC MINOR SOURCE Fee
Applicability Determination (100734) $500
Applicability Determination (100922) $500
GP- Authorization to Construct (100778) $900
PBR – Construct (100985) $250
GP- Authorization to Operate (100788) $900
PBR – Operate (100989) $100
Part 70 Construction (100150) $7,500
GP – Authorization to Construct (100826) $500
Part 70 Construction Modification (100779) $5,000
GP – Authorization to Operate (100827) $500
Part 70 Operation (100733) $7,500
Construction (100829) $2,000
Part 70 Minor Modification (100781) $3,000
Permit Amendment – no emission increase (100830) $500
Part 70 Significant Modification (100786) $6,000
Operating Permit (100831) $750
Part 70 Renewal (100787) $7,500
Operating Permit Modification (100833) $750
Part 70 Relocation (100782) $500
Relocation (100834) $250 Application Type Confirmed – (AQD Use Only)
GP or PBR Name (If Applicable):
Existing Permit Number (If Applicable)
PAYMENT INFORMATION
Please choose one payment type, and attach payment – payable to the Department of Environmental Quality (no cash can be accepted). Please reference the facility name (or existing permit or Authorization number) on the check or money order. Payment Type
Check
Money order Amount/ Receipt Confirmed by: (DEQ Use Only) Amount:
$ Check or Money Order Number:
Date:
DEQ Form #100-815 Revised March 1, 2012
TIER DETERMINATION INFORMATION
OAC 252:004-7 categorizes different types of Air Quality applications as Tier I, II, or III, depending on their complexity and the amount of public interest under DEQ’s “Uniform Permitting” system. The Tier classification affects the amount of public review given the application. Applicants may use the following format as a checklist for determining Tier classification.
OAC 252:4-7-32. Air quality applications - Tier I
(1) New construction, operating and relocation permit for a minor facility.
(2) Modification of a construction permit for a minor facility that will remain minor after the modification.
(3) Modification of an operating permit that will not change the facility’s classification from minor to major.
(4) Extension of expiration date of a minor facility construction permit.
(5) New construction permit for an existing Part 70 source for any facility change considered minor under OAC 252:100-8-7.2(b)(1).
(6) New operating permit for a Part 70 source that is based on a construction permit that was processed under Tier II or III, 252:100-8-8 and has conditions which do not differ from the construction permit’s operating conditions in any way considered significant under OAC 252:100-8-7.2(b)(2).
(7) Modification of any Part 70 source operating permit condition that is based on the operating conditions of a construction permit that was processed under Tier II or Tier III and OAC 252:100-8-8, and does not differ from those construction permit conditions in any way considered significant under OAC 252:100-8-7.2(b)(2).
(8) A construction or operating permit modification that is minor under OAC 252:100-8-7.2(b)(1).
(9) Extension of expiration date of a Part 70 source’s construction permit with no or minor modifications.
(10) New, modified and renewed individual authorizations under general operating permits for which a schedule of compliance is not required by OAC 252:100-8-5(e)(8)(B)(i).
(11) Burn approvals.
(12) Administrative amendments of all air quality permits and other authorizations.
OAC 252:4-7-33. Air quality applications - Tier II
(1) A minor facility seeking a permit for a facility modification that when completed would turn it into a Part 70 source.
(2) New construction permit for a new Part 70 source not classified under Tier III.
(3) New construction permit for an existing Part 70 source for any facility change considered significant under OAC 252:100-8-7.2(b)(2) and which is not classified under Tier III.
(4) New operating permit for a Part 70 source that did not have an underlying construction permit processed under Tier II or Tier III, and OAC 252:100-8-8.
(5) New operating permit for a Part 70 source with one or more conditions that differ from the underlying Tier II or Tier III construction permit’s operating conditions in a way considered significant under OAC 252:100-8-7.2(b)(2).
(6) New acid rain permit that is independent of a Part 70 permit application.
(7) New temporary source permit under OAC 252:100-8-6.2.
(8) Significant modification, as described in OAC 252:100-8-7.2(b)(2), of a Part 70 operating permit that is not based on an underlying construction permit processed under Tier II or Tier III, and OAC 52:100-8-8.
(9) Modification of a Part 70 operating permit when the conditions proposed for modification differ from the underlying construction permit’s operating conditions is an way considered significant under OAC 252:100-8-7.2(b)(2).
(10) A Part 70 construction permit modification considered significant under OAC 252:100-8-7.2(b)(2) and which is not classified under Tier III.
(11) Renewals of operating permits for Part 70 sources.
(12) New, modified and renewed general operating permits.
(13) Individual authorizations under any general operating permit for which a schedule of compliance is required by OAC 252:100-8-5(c)(8)(B)(i).
(14) Plant-wide emission plan approval under OAC 252:100-37-25(b) or OAC 252:100-39-46(j).
(15) Alternative emissions reduction authorizations.
OAC 252:4-7-34. Air quality applications - Tier III
(a) A construction permit for any new major stationary source listed in this subsection requires a Tier III application. For purposes of this section, "Major stationary source" means:
(1) Any of the following sources of air pollutants which emits, or has the PTE, 100 TPY or more of any pollutant subject to regulation:
(A) carbon black plants (furnace process),
(B) charcoal production plants,
(C) chemical process plants,
(D) coal cleaning plants (with thermal dryers),
(E) coke oven batteries,
(F) fossil-fuel boilers (or combustion thereof),totaling more than 250 million BTU per hour heat input,
(G) fossil fuel-fired steam electric plants of more than 250 million BTU per hour heat input,
(H) fuel conversion plants,
(I) glass fiber processing plants,
(J) hydrofluoric, sulfuric or nitric acid plants,
(K) iron and steel mill plants,
(L) kraft pulp mills,
(M) lime plants,
(N) incinerators, except where used exclusively as air pollution control devices,
(O) petroleum refineries,
(P) petroleum storage and transfer units with a total storage capacity exceeding 300,000 barrels,
(Q) phosphate rock processing plant,
(R) portland cement plants,
(S) primary aluminum ore reduction plants,
(T) primary copper smelters,
(U) primary lead smelters,
(V) primary zinc smelters,
(W) secondary metal production plants,
(X) sintering plants,
(Y) sulfur recovery plants, or
(Z) taconite ore processing plants, and
(2) Any other source not specified in paragraph (1) of this definition which emits, or has the PTE, 250 TPY or more of any pollutant subject to regulation.
(b) Existing incinerators. An application for any change in emissions or potential to emit, or any change in any permit condition, that would have caused an incinerator to be defined as a major stationary source when originally permitted shall require a Tier III application.
(c) Potential to emit. For purposes of this section, "potential to emit" means emissions resulting from the application of all enforceable permit limitations as defined in OAC 252:100-1-3.

Description

Agency	Environmental Quality, Oklahoma Department of
Agency Code	'292'
Form Title	Minor Source Permit Application for a Rock Crushing Facility or a Sand & Gravel Operation
Frequency	One-Time
AgencyDivisionDeptBranch	AQD/Permits
Form Number	DEQ 100-110
Full Text	MINOR SOURCE PERMIT APPLICATION for a ROCK CRUSHING FACILITY or a SAND & GRAVEL OPERATION FORMS & INSTRUCTIONS AIR QUALITY DIVISION STATE OF OKLAHOMA DEPARTMENT OF ENVIRONMENTAL QUALITY 707 N. ROBINSON AVE., SUITE 4100 P.O. BOX 1677 OKLAHOMA CITY, OK 73101-1677 PHONE: (405) 702-4100 FAX: (405) 702-4101 REVISED AUGUST 28, 1997 Instructions Revised March 1, 2012 MINOR SOURCE APPLICATION INSTRUCTIONS ROCK CRUSHING FACILITIES SAND & GRAVEL OPERATIONS ASSISTANCE AVAILABLE DEQ Customer Assistance: (800) 869-1400 Air Quality Division: (405) 702-4100 INTRODUCTION This package contains the State of Oklahoma Air Quality Permit Application for a Minor Source. Please read all the directions carefully before you fill it out. Answer all questions by checking the appropriate box or filling in a response. Original signature from a responsible official is required on Form 884. Please note that delays in processing your application may occur if an incomplete application is submitted. It is the applicant’s responsibility to submit a complete application well in advance of anticipated commencement of construction, start up dates, or the effective date of operating permit program requirements to allow sufficient time for proper application review and permit issuance. BACKGROUND Oklahoma operates a dual air quality permit system under Oklahoma Administrative Code (OAC) 252:100. A construction permit is to be obtained prior to the commencement of construction, installation or modification of any source which will increase the amount of air contaminant emissions by more than the de minimis levels given in OAC 252:100-7-2. After construction is completed, application for an operating permit must be submitted within 60 days after start up. If you are uncertain whether a permit is required, a request for an applicability determination may be submitted to DEQ and a written determination will be made based on the data submitted. An applicability determination can also be performed to determine whether a facility is a major or minor source. DEFINITIONS Criteria Pollutant: Oxides of Nitrogen (NOx), Sulfur Dioxide (SO2), Lead (Pb), Ozone (O3, i.e., regulated as non-methane hydrocarbon or NMHC as a precursor to O3), Particulate Matter less than 10 microns (PM10), Carbon Monoxide (CO). Minor Source: A source that has the potential to emit less than 100 tons/year of a criteria pollutant, less than 10 tons/year of any single hazardous air pollutant, and less than 25 tons/year total hazardous air pollutants in the aggregate. These sources are classified as Tier I sources and follow the simplest type of application process. Synthetic Minor Source: A source which has the potential under maximum operating conditions to emit at the Major Source level but which has a permit which restricts emissions to the minor source level. Such restrictions may include any of the following: hours of operation, emission control devices, and throughput. Applications for minor source permits are classified as either Tier I or Tier II, depending on several factors. Major Source: A source that has the potential to emit more than 100 tons/year for criteria pollutants, 25 tons/year of hazardous air pollutants, or 10 tons/year of any single hazardous air pollutant. Additionally, a Major Source will not have permit requirements which restrict all actual criteria pollutant and hazardous air pollutant emissions to less than these levels. These sources are complex in their potential impact and are subject to the Tier II or Tier III application process. TIER DETERMINATION DEQ’s “Uniform Permitting” system, under OAC 252:002, categorizes applications as Tier I, II, or III, depending on their complexity and the amount of public interest. The main effect of a Tier classification is the amount of public review given the application. For Air Quality permits, Tier I basically includes minor sources and most synthetic minor sources. Tier II covers major sources, and Tier III covers only very large sources such as those requiring PSD review. This packet is designed (only) to meet the application requirements for most Rock Crushing Facilities and Sand & Gravel Operations which are minor sources or synthetic minor sources and qualify as Tier I applications. Other facilities, including those with emission units not covered in this application packet and those that need emissions modeling assistance, should contact Air Quality for information or additional forms and/or worksheets. PERMIT FEES Applicants must attach a check or money order (no cash will be accepted) payable to the DEQ Air Quality Division in accordance with Form 100-815, which is included in this packet. APPLICATION MUST INCLUDE: SUBMIT 3 COPIES OF COMPLETED APPLICATON TO: 1. DEQ Form # 100-884 (General Facility Information Form) DEPARTMENT OF ENVIRONMENTAL QUALITY 2. DEQ Form # 100-110 (Emission Units information for each unit on site) AIR QUALITY DIVISION 3. DEQ Form # 100-810 (Landowner Affidavit) 707 N ROBINSON, SUITE100 4. DEQ Form # 100-815 (AQ Application Classification Fees) P.O. Box 1677 5. Appropriate fees (check payable to DEQ Air Quality Division) OKLAHOMA CITY, OK 73101-1677 6. Facility Plot Plan & Process Flow Diagram DEQ Form 100-810 Revised 7/10/02 Tier I, II, or III permit applicants must provide notice to the landowner(s). The basis for this requirement is Title 27A of the Oklahoma Statutes, Supplement 1996, § 2-14-103(9), as described in OAC 252:4-7-13 (b). Please note that you MUST fill out and return this affidavit even if you don’t have to give any landowner notice. A NOTICE TO THE LANDOWNER(S) IS NOT REQUIRED because: (check one) My application does not involve any land. My application involves only land owned by me (or applicant business). I have a current lease given to accomplish the permitted purpose. I have a current easement given to accomplish the permitted purpose. OR B NOTICE TO THE LANDOWNER(S) IS REQUIRED because the land is owned by someone other than myself or the applicant business AND I HAVE NOTIFIED the following (check one): Landowner(s) Lessor or Administrator or Executor of the land METHOD OF DELIVERY (check one): Actual notice, for which I have a signed and dated receipt Service by Sheriff or private process server, for which I have an affidavit Service by certified mail, restricted delivery, for which I have a signed return receipt Legal publication, for which I have an affidavit of publication from the newspaper, because the landowners could not be located through due diligence LANDOWNER AFFIDAVIT CERTIFICATION I, as the applicant or an authorized representative of the applicant, hereby certify that I own the real property, have a current lease or easement which is given to accomplish the permitted purpose (per Option A above), or have provided legal notice to the landowner(s) (per Option B above) about the permit application for the facility described below. Company Name Facility Name Facility Address or Legal Description. Responsible Official (signature) Date Signed Responsible Official (typed) Title If the landowner notice applies to your application (Option B above) you can send the following form to them as your notice: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - DEQ LANDOWNER NOTIFICATION AFFIDAVIT NOTICE TO LANDOWNER OF FILING Dear Landowner: (Name) (Applicant name) has filed a permit application with the Oklahoma Department of Environmental Quality for (Facility Name) facility. This application involves the land owned by you located at: Address or Legal Description: Signed: Date: DEQ Form # 100-884 Revised July 30, 2010 AIR QUALITY PERMIT APPLICATION GENERAL FACILITY INFORMATION APPLICATION NUMBER (AQD Use Only) 1 COMPANY INFORMATION Name Mailing Address City State Zip 2 APPLICATION TYPE Applicability Determination Construction Permit Operating Permit GP Authorization To Operate GP Authorization To Construct GP Name: Renewal Modification Relocation PBR PBR Type: Permit Number(s) (If Applicable) Est. Date of Construction/Modification Start: Operational Start-up: Completion: 3 IS CONFIDENTIAL INFORMATION INCLUDED? YES NO By including confidential information, Applicant acknowledges that such information may be shared with the U.S. Environmental Protection Agency for purposes consistent with the Federal Clean Air Act, 42 U.S.C. §§ 4201 et. seq. 4 TIER CLASSIFICATION Tier I Tier II Tier III N/A – AD only FACILITY TYPE Major Minor Synthetic Minor 5 FEES SUBMITTED $ CHECK # DATE 6 TECHNICAL CONTACT Name Phone Fax Email Address Company Name Street Address City State Zip 7 FACILITY INFORMATION Name SIC Code(s) NAICS Code(s) Contact Person Title Phone LEGAL DESCRIPTION Sub Section Section Township Range Physical Address or Driving Directions City or Nearest Town Zip County 8 GEOGRAPHIC COORDINATES Latitude (to 5 Decimals) Longitude (to 5 Decimals) DATA SOURCE GPS DEQ Data Viewer Web Viewer (Specify): Center of Township & Range Section or relevant subsection Street Address (Conversion Program): Unknown Other (Specify): REFERENCE POINT Facility Entrance Point or First Gate of Lease Property (preferred above all other options) Center of Facility Unknown Other (Specify): 9 APPLICATION CERTIFICATION This application, including all attachments, has been submitted as required by OAC 252:100. I certify that (a) I am the Responsible Official for this company as defined in OAC 252:100-3; and (b) based on information and belief formed after reasonable inquiry, the statements and information contained in this application are true, accurate, and complete. Responsible Official (name) Title Responsible Official (signature) Date Phone Fax Email Address Street Address City State Zip DEQ Form # 100-110 PAGE 1 of 2 Revised 8/28/97 EMISSION UNITS - ROCK CRUSHING & SAND FACILITIES MINOR SOURCE EQUIPMENT DESCRIPTION In the table below, please list all emission units, (e.g., hoppers, crushers, grinders, screens, stockpiles, organic liquid storage tanks, and other miscellaneous equipment) located at the facility. For each unit, give an unique identifier (e.g. facility numbering system or emissions inventory ID#), number of operation hours per year, the equipment installation date (actual or projected), and the date the equipment was manufactured or modified. In the last column, indicate whether the unit is a subject of the requested permit action (Construction or Operating Permit, or Modification of an existing permit). EMISSION UNITS (Equipment) Operating Hours Manufacture or Modify Installation Date Unit Subject of this Permit Action? ID # Description Per Year Date Yes No Please provide the following information for each piece of equipment which is subject of the requested permit action. Data submitted for construction permits should be a best estimate. The values may be modified following construction and/or subsequent testing. This information is necessary to determine the emissions. Indicate crusher type according to product size, as used in AP-42, (1/95), Section 11.19.2: primary (3 to 12 inches), secondary (1 to 4 inches), or tertiary (3/16th to 1 inch). Likewise, indicate for each screen whether it serves as a fines screen or “other.” Provide the requested information for each transfer point, including truck unloading, if applicable. EMISSION POINTS – CRUSHERS/GRINDERS Process Rate Controls Emission Factor (lb/ton) ID# Crusher Type (TPH) Type Efficiency Controlled Uncontrolled SCREENS Process Rate Controls Emission Factor (lb/ton) ID# Screen Type (TPH) Type Efficiency Controlled Uncontrolled DEQ Form # 100-110 PAGE 2 of 2 Revised 8/28/97 OTHER EQUIPMENT Process Rate Controls Emission Factor (lb/ton) ID# Equipment Type (TPH) Type Efficiency Controlled Uncontrolled STOCKPILES (Total Estimated Fugitives from Storage Piles) Stockpile Area Controls Emission Factor (lb/acre/day) ID# Stored Material (Acres) Type Efficiency Controlled Uncontrolled MATERIAL TRANSFER POINTS Process Rate Controls Emission Factor (lb/ton) From (ID#) To (ID#) (TPH) Type Efficiency Controlled Uncontrolled EMISSIONS DATA SOURCE AP-42 (Jan. ’95) Other (Specify): CONTROL OF FUGITIVE DUST FROM VEHICLE TRAVEL Miles of Paved Facility Roads Miles of Unpaved Facility Roads Road Dust Suppression Practices Water Truck Road Oiling OCC Permit #: Other (Specify): Please provide the following information if organic liquid storage tanks (e.g., fuel, solvents) with capacity of 400 gallons or more are operated at the facility. Data submitted for construction permits should be a best estimate. The values may be modified following construction and/or subsequent testing. Applicants must fill out a complete table for each such tank which has a capacity of 400 gallons or more. STORAGE TANKS Tank ID # Construction / Modification Date Type of Liquid Stored: Gasoline Diesel Other (Specify): Tank Capacity (gallons) Vapor Pressure (psia) Tank Height (ft) Tank Diameter (ft) Maximum Throughput (gallons/year) Tank Color Controls: Submerged Fill Pipe Vapor Recovery System Other (Specify): DEQ Form #100-815 Revised March 1, 2012 AIR QUALITY DIVISION CLASSIFICATION OF AQ PERMIT APPLICATIONS & APPLICATION FEES Application Number (AQD Use Only) Company Name Facility Name Mailing Address City State Zip This form is used to document both a preliminary determination of the Tier classification and any associated Application Fee. Step 1: APPLICATION CLASSIFICATION AND TIER DETERMINATION DEQ’s “Uniform Permitting” system, under OAC 252:004, categorizes different types of applications as Tier I, II, or III, depending on their complexity and the amount of public interest. The main effect of a Tier classification is the amount of public review given the application. For Air Quality permits, Tier I basically includes minor facilities and most synthetic minor facilities. Tier II covers major sources, and Tier III covers only very large sources such as those requiring PSD review. Additional information to make a preliminary determination of the Tier classification is provided on the next page. This determination will be verified before permit issuance. Note that all Tier II and III applications require public notice of the application in one newspaper local to the site or facility as soon after the filing date as possible. Other public participation requirements, such as notice of draft and proposed permit, and notice of public meeting may also be required. Contact our office for more information on these requirements. TIER CLASSIFICATION Tier I Tier II Tier III N/A – AD only FACILITY TYPE Major Minor Synthetic Minor Confirmed/Corrected by: (AQD Use Only) Step 2: APPLICATION TYPE & FEE Application fee may be determined according to the following schedule. The emissions level is based on the single criteria pollutant with the highest emissions rate. Fees are subject to change – please refer to OAC 252:100-7-3 or 252:100-8-1.7 for the latest fee schedule. MAJOR SOURCE Fee MINOR OR SYNTHETIC MINOR SOURCE Fee Applicability Determination (100734) $500 Applicability Determination (100922) $500 GP- Authorization to Construct (100778) $900 PBR – Construct (100985) $250 GP- Authorization to Operate (100788) $900 PBR – Operate (100989) $100 Part 70 Construction (100150) $7,500 GP – Authorization to Construct (100826) $500 Part 70 Construction Modification (100779) $5,000 GP – Authorization to Operate (100827) $500 Part 70 Operation (100733) $7,500 Construction (100829) $2,000 Part 70 Minor Modification (100781) $3,000 Permit Amendment – no emission increase (100830) $500 Part 70 Significant Modification (100786) $6,000 Operating Permit (100831) $750 Part 70 Renewal (100787) $7,500 Operating Permit Modification (100833) $750 Part 70 Relocation (100782) $500 Relocation (100834) $250 Application Type Confirmed – (AQD Use Only) GP or PBR Name (If Applicable): Existing Permit Number (If Applicable) PAYMENT INFORMATION Please choose one payment type, and attach payment – payable to the Department of Environmental Quality (no cash can be accepted). Please reference the facility name (or existing permit or Authorization number) on the check or money order. Payment Type Check Money order Amount/ Receipt Confirmed by: (DEQ Use Only) Amount: $ Check or Money Order Number: Date: DEQ Form #100-815 Revised March 1, 2012 TIER DETERMINATION INFORMATION OAC 252:004-7 categorizes different types of Air Quality applications as Tier I, II, or III, depending on their complexity and the amount of public interest under DEQ’s “Uniform Permitting” system. The Tier classification affects the amount of public review given the application. Applicants may use the following format as a checklist for determining Tier classification. OAC 252:4-7-32. Air quality applications - Tier I (1) New construction, operating and relocation permit for a minor facility. (2) Modification of a construction permit for a minor facility that will remain minor after the modification. (3) Modification of an operating permit that will not change the facility’s classification from minor to major. (4) Extension of expiration date of a minor facility construction permit. (5) New construction permit for an existing Part 70 source for any facility change considered minor under OAC 252:100-8-7.2(b)(1). (6) New operating permit for a Part 70 source that is based on a construction permit that was processed under Tier II or III, 252:100-8-8 and has conditions which do not differ from the construction permit’s operating conditions in any way considered significant under OAC 252:100-8-7.2(b)(2). (7) Modification of any Part 70 source operating permit condition that is based on the operating conditions of a construction permit that was processed under Tier II or Tier III and OAC 252:100-8-8, and does not differ from those construction permit conditions in any way considered significant under OAC 252:100-8-7.2(b)(2). (8) A construction or operating permit modification that is minor under OAC 252:100-8-7.2(b)(1). (9) Extension of expiration date of a Part 70 source’s construction permit with no or minor modifications. (10) New, modified and renewed individual authorizations under general operating permits for which a schedule of compliance is not required by OAC 252:100-8-5(e)(8)(B)(i). (11) Burn approvals. (12) Administrative amendments of all air quality permits and other authorizations. OAC 252:4-7-33. Air quality applications - Tier II (1) A minor facility seeking a permit for a facility modification that when completed would turn it into a Part 70 source. (2) New construction permit for a new Part 70 source not classified under Tier III. (3) New construction permit for an existing Part 70 source for any facility change considered significant under OAC 252:100-8-7.2(b)(2) and which is not classified under Tier III. (4) New operating permit for a Part 70 source that did not have an underlying construction permit processed under Tier II or Tier III, and OAC 252:100-8-8. (5) New operating permit for a Part 70 source with one or more conditions that differ from the underlying Tier II or Tier III construction permit’s operating conditions in a way considered significant under OAC 252:100-8-7.2(b)(2). (6) New acid rain permit that is independent of a Part 70 permit application. (7) New temporary source permit under OAC 252:100-8-6.2. (8) Significant modification, as described in OAC 252:100-8-7.2(b)(2), of a Part 70 operating permit that is not based on an underlying construction permit processed under Tier II or Tier III, and OAC 52:100-8-8. (9) Modification of a Part 70 operating permit when the conditions proposed for modification differ from the underlying construction permit’s operating conditions is an way considered significant under OAC 252:100-8-7.2(b)(2). (10) A Part 70 construction permit modification considered significant under OAC 252:100-8-7.2(b)(2) and which is not classified under Tier III. (11) Renewals of operating permits for Part 70 sources. (12) New, modified and renewed general operating permits. (13) Individual authorizations under any general operating permit for which a schedule of compliance is required by OAC 252:100-8-5(c)(8)(B)(i). (14) Plant-wide emission plan approval under OAC 252:100-37-25(b) or OAC 252:100-39-46(j). (15) Alternative emissions reduction authorizations. OAC 252:4-7-34. Air quality applications - Tier III (a) A construction permit for any new major stationary source listed in this subsection requires a Tier III application. For purposes of this section, "Major stationary source" means: (1) Any of the following sources of air pollutants which emits, or has the PTE, 100 TPY or more of any pollutant subject to regulation: (A) carbon black plants (furnace process), (B) charcoal production plants, (C) chemical process plants, (D) coal cleaning plants (with thermal dryers), (E) coke oven batteries, (F) fossil-fuel boilers (or combustion thereof),totaling more than 250 million BTU per hour heat input, (G) fossil fuel-fired steam electric plants of more than 250 million BTU per hour heat input, (H) fuel conversion plants, (I) glass fiber processing plants, (J) hydrofluoric, sulfuric or nitric acid plants, (K) iron and steel mill plants, (L) kraft pulp mills, (M) lime plants, (N) incinerators, except where used exclusively as air pollution control devices, (O) petroleum refineries, (P) petroleum storage and transfer units with a total storage capacity exceeding 300,000 barrels, (Q) phosphate rock processing plant, (R) portland cement plants, (S) primary aluminum ore reduction plants, (T) primary copper smelters, (U) primary lead smelters, (V) primary zinc smelters, (W) secondary metal production plants, (X) sintering plants, (Y) sulfur recovery plants, or (Z) taconite ore processing plants, and (2) Any other source not specified in paragraph (1) of this definition which emits, or has the PTE, 250 TPY or more of any pollutant subject to regulation. (b) Existing incinerators. An application for any change in emissions or potential to emit, or any change in any permit condition, that would have caused an incinerator to be defined as a major stationary source when originally permitted shall require a Tier III application. (c) Potential to emit. For purposes of this section, "potential to emit" means emissions resulting from the application of all enforceable permit limitations as defined in OAC 252:100-1-3.
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Minor Source Permit Application for a Rock Crushing Facility or a Sand & Gravel Operation

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