PRINTABLE FORM FOR REPORTING ON A 12-MONTH ROLLING BASIS Facility ID #: Company Name: Address: Prepared By: Phone Number:
(
) 2nd Quarter 3rd Quarter 4th Quarter
Reporting Period (circle one): 1st Quarter Reporting Parameter: Reporting Units:
(e.g. SO2, VOC, asphalt production, fuel oil usage, etc.) (e.g. gals, lbs, tons, etc.)
Table 1 - Monthly Usage/Emissions for the 11 Months Prior to Reporting Period Item # Month 1 2 3 4 5 6 7 8 9 10 11 Table 2 - Monthly Usage for the Three Months of Reporting Period Month 12 13 14 Note: This worksheet is to aid in the calculation of production parameters or pollutant emissions for quarterly reporting. Year Monthly Total Months for Table 2, Items 12-14 1st Quarter: January - March 2nd Quarter: April - June 3rd Quarter: July - September 4th Quarter: October - December Table 3 - Cumulative Annual Usage/Emissions Ending Each Month of Reporting Period in Reporting Units per Year. (tons/yr, gals/yr, lbs/yr…) (total items 1 - 12) (total items 2 - 13) (total items 3 - 14) Year Monthly Total Notes Months for Table 1, Items 1 - 11 1st Quarter: February - December 2nd Quarter: May - March 3rd Quarter: August - June 4th Quarter: November - September
s:\formltrs\complnce\dea4806e-ec56-4069-9417-5434b17b74f6.xls
6:09 PM 11/26/2008
SPREADSHEET FOR REPORTING ON A 12-MONTH ROLLING BASIS (Calculates 12-month Rolling Totals) Facility ID #: Company Name: Address: Prepared By: Phone Number:
(
) 2nd Quarter 3rd Quarter 4th Quarter
Reporting Period (circle one): 1st Quarter Reporting Parameter: Reporting Units:
(e.g. SO2, VOC, asphalt production, fuel oil usage, etc.) (e.g. gals, lbs, tons, etc.)
Table 1 - Monthly Usage/Emissions for the 11 Months Prior to Reporting Period Item # Month 1 2 3 4 5 6 7 8 9 10 11 Table 2 - Monthly Usage for the Three Months of Reporting Period Month 12 13 14 Note: This worksheet is to aid in the calculation of production parameters or pollutant emissions for quarterly reporting. Year Monthly Total Months for Table 2, Items 12-14 1st Quarter: January - March 2nd Quarter: April - June 3rd Quarter: July - September 4th Quarter: October - December Table 3 - Cumulative Annual Usage/Emissions Ending Each Month of Reporting Period in Reporting Units per Year. (tons/yr, gals/yr, lbs/yr…) (total items 1 - 12) 0 (total items 2 - 13) 0 (total items 3 - 14) 0 Year Monthly Total Notes Months for Table 1, Items 1 - 11 1st Quarter: February - December 2nd Quarter: May - March 3rd Quarter: August - June 4th Quarter: November - September
s:\formltrs\complnce\dea4806e-ec56-4069-9417-5434b17b74f6.xls
6:09 PM 11/26/2008