Air Toxic

							                                       Logsheet to Record Start-up, Shutdowns and Malfunctions - Draft
Plant Name :                                                                              Address



                                     Total               Check if Normal     What Malfunctioned?        Describe abnormal start-up/shutdown and/or                 Followed SSM Initials
Date           Start time   End Time Time         Start-up     shutdown      Equipment Temp. monitoring malfunction and what you did to correct it.                Plan
                                                                                        system
ex-8/1/2003     8:00 AM      5:00pm    9 hours          x               x                                                                                          yes            LPH
ex-8/1/2003      1:00pm      2:00pm    1 hour                                burner                           burner motor failed; had spare on-site;replaced.     yes            LPH




Note: If start-up, shutdown or malfunction is not covered by the plan or what you did to fix the malfunction was different than your SSM plan you
must fax or call with-in 2 days following up with a letter within 7 days. If the continuous emission monitoring system malfunctioned and it is not covered by the plan or
what you did to fix it was not covered in your SSM plan+A8 then you must fax or call with-in 24 hours following up with a letter within 14 days.

The above report maybe be used as your semi-annual SSM report to be sent in 30 days after the end of each calendar half. (due July 30th and January 30th)

I CERTIFY THE INFORMATION ABOVE TO BE ACCURATE AND TRUE TO THE BEST OF MY KNOWLEDGE. ACTIONS TAKEN DURING SS&M EVENTS WERE
CONSISTENT WITH THE SSM PLAN; Letters/forms explaining actions that were inconsistent with the plan are attached to this form.
The plan has been revised to incorporate these events.


               Name                                             Title

               Signature                                        date
Sample Start-up, Shutdown, & Malfunction Report Form - DRAFT

Plant:
Address:




Malfunctioning device:

Date of Malfunction:

Time malfunction began (estimated):                     Time malfunction ended:
Total duration of malfunction: (in hours & minutes)

Suspected cause of malfunction:




Corrective action(s) taken:




Was this malfunction covered by the Malfunction Plan?
          yes             no

Were your actions consistent with the Malfunction Plan during the malfunction?
          yes             no

If your actions were not consistent with the Malfunction Plan during the
malfunction, explain why you took other actions:




Do you believe that any excess emissions and/or parameter monitoring exceedances
occurred during the malfunction?       yes          no

Which, if any, units were shut down because of malfunction:

Your name:                                              Title

Signature of Responsible Official:
Title:
Note: Fax or call this information in to proper authorities within 2 working days of the event
and sent a letter within 7 working days of the event
If malfunction occurred on the temperature monitoring system then Fax or call this
information in with-in 24 hours and follow-up with a letter with-in 14 days