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Iowa Insignificant Activities 1.3

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IOWA OPERATING PERMIT APPLICATION – PART 1
Form 1.3 INSIGNIFICANT ACTIVITIES – POTENTIAL EMISSION (567 IAC 22.103)
    1) Company/Facility Name                                                                           2) EIQ No.                                               3) Form 1.3

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                                                                   APPLICATION FOR DESIGNATION AS LISTED INSIGNIFICANT ACTIVITY
                  List the Potential Emissions (Pounds/Year) for each Emission Unit to be considered as an Insignificant Activity (see exempted units and limitations 567 IAC 22.103)
    4) Emission       5) Emission Unit Description                                                                                                                                                             17) Toxics –
                                                                                                       9) Sulfur    10) Reduced   11) Total                                                      16) High Risk
    Unit No.          [Include max. vapor pressure for contents of       6) CO   7) NOx       8) SO2   Acid Mists   Sulfur Cpds               12) PM-10   13) VOC     14) Lead   15) Fluorides
                                                                                                                                                                                                 Toxics
                                                                                                                                                                                                               not high risk
                                                                                                                                  PM                                                                           group
                      storage tanks (22.103(2)"b"(5) classification)]




    18) Totals this page (Pounds/Year)

    19) Facility Totals (Tons/Year)

     Place facility totals on First page of Form 1.3
Duplicate this form as needed                                                             TYPE OR PRINT ALL INFORMATION                                         (DNR Form 542-1477. December 2009)


              Form 1.3                                                                                                                                                                                                    

				
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