FORM 5
MISSISSIPPI DEPARTMENT OF ENVIRONMENTAL
QUALITY APPLICATION FOR AIR POLLUTION
CONTROL PERMIT
MDEQ
Fuel Burning Equipment – Internal Combustion Engines
1.
Emission Point Description
A.
Emission Point Designation (Ref. No.):
B.
Equipment Description:
C.
Manufacturer:
E.
Maximum Heat Input (higher heating value):
F.
Rated Power:
G.
Use:
H.
Displacement per cylinder:
I.
Engine Ignition Type:
J.
Engine Burn Type:
(check all that apply)
K.
Design Controls (e.g., catalytic converter, diesel
particulate filter, etc.)
L.
Status:
M
Engine manufactured date:
O.
If an emergency engine, can your engine be operated for Emergency
Demand Response per the NERC Reliability Standard?
☐ Yes
☐
No
If an emergency engine, is it used for peak shaving or non-emergency
demand response?
☐ Yes
☐
No
P.
Q.
2.
Section D
D.
Model Yr. and No.:
MMBtu/hr
hp
kW
Non-emergency
Operating
Emergency
Liters
Spark Ignition
4-stroke
Compression Ignition
2-stroke
Rich Burn
Proposed
Lean Burn
Under Construction
N.
Engine order date:
Date of construction, reconstruction, or most recent modification (for
existing sources) or date of anticipated construction:
Fuel Type
Complete the following table, identifying each type of fuel and the amount used. Specify the units for heat
content, hourly usage, and yearly usage.
FUEL TYPE
HEAT
% SULFUR
% ASH
MAXIMUM
MAXIMUM
CONTENT
HOURLY USAGE YEARLY USAGE
Please list any fuel components that are hazardous air pollutants and the percentage in the fuel:
Form 5 Air Application 2013.1
MISSISSIPPI DEPARTMENT OF ENVIRONMENTAL QUALITY APPLICATION FOR AIR
FORM 5
MDEQ
POLLUTION CONTROL PERMIT
Fuel Burning Equipment – Internal Combustion Engines
3.
Section D
Pollutant Emissions
Example emission rate calculations, monitoring data, or stack test data must be attached in accordance with the Permit Application Instructions.
EMISSION
POINT
POLLUTANT
note 1
CONTROL
EQUIPMENT
yes/no2
efficiency (%)
POTENTIAL UNCONTROLLED
EMISSION RATE (if different than
the Proposed Allowable)
note 3
lb/hr
tons/yr
PROPOSED ALLOWABLE/
POTENTIAL TO EMIT
EMISSION RATE
note 3
lb/hr
tons/yr
1. All regulated air pollutants including hazardous air pollutants emitted from this source should be listed in accordance with the Permit
Application Instructions. A list of regulated air pollutants and hazardous air pollutants is provided in the Application Instructions.
2. If yes, attach the appropriate Air Pollution Control Data Sheet from Section L.
3. Provide emission rate in units of any applicable emission standard, e.g. lb/MMBTU, gr/dscf, etc. This may not apply to every emission
point or every pollutant from an emission point.
Form 5 Air Application 2013.1