2700-FM-AQ0095 9/2007 COMMONWEALTH OF PENNSYLVANIA

DEPARTMENT OF ENVIRONMENTAL PROTECTION

BUREAU OF AIR QUALITY

ADMINISTRATIVE COMPLETENESS CHECKLIST

In accordance with 25 Pa Code, Section 127.12d, the Department will determine whether the application is administratively complete within 30 days. If the Department determines that the application is not administrative complete, the Department will request supplemental information.

I. Application Information

Facility Name:
Facility Location:
Federal ID Number:
Contact Name:
Contact Phone Number:

II. Application Information

General Information Form (GIF) attached? / YES / NO
Correct Plan Approval Form(s) used? / YES / NO
Copy of Municipal Notifications submitted with proof of receipt? / YES / NO
Correct Application Fees received? / YES / NO

2700-FM-AQ0095 9/2007 COMMONWEALTH OF PENNSYLVANIA

DEPARTMENT OF ENVIRONMENTAL PROTECTION

BUREAU OF AIR QUALITY

General (Subchapter B) = $1,000.00
Or the sum of the types listed below:
New Source Review (Subchapter E) = $5,300.00
New Source Performance Standards (Chapter 122) = $1,700.00
National Emission Standards for Hazardous Air Pollutants = $1,700.00
(Chapter 124)
Maximum Achievable Control Technology (Section 127.35©, (d), or (h) = $8,000.00
Prevention of Significant Deterioration (Subchapter D) = $22,700.00
TOTAL =

2700-FM-AQ0095 9/2007 COMMONWEALTH OF PENNSYLVANIA

DEPARTMENT OF ENVIRONMENTAL PROTECTION

BUREAU OF AIR QUALITY

Submitted in triplicate? / YES / NO
Application signed by the responsible official? / YES / NO
Compliance Review Form and/or Supplemental Form included? / YES / NO

III. Application Evaluation

All applicable Sections of the application completed? / YES / NO
Application information sufficient to begin the technical review? / YES / NO
If “NO”, request supplemental information by:
Supplemental Information Required:
Date of application received by DEP: / Plan Approval / Permit Number:
Reviewed By: / Date:

2700-FM-AQ0095 9/2007

ADMINISTRATIVE COMPLETENESS CHECKLIST

IV. Details Application Evaluation

Section A, Applicant Identity & Checklist / YES / NO
Section B, Source Category Information
* Source Information / YES / NO / N/A
* Fuel Information / YES / NO / N/A
* Miscellaneous Information / YES / NO / N/A
Section C, Air Cleaning Device:
* Pre-control emissions / YES / NO / N/A
* Air cleaning device(s) information / YES / NO / N/A
* Cost analysis to support BAT determination, if necessary / YES / NO / N/A
* Information such as emissions calculation,
Manufacturer guarantee, maintenance schedule / YES / NO / N/A
Section D, Applicable Requirements
* A demonstration that the sources meets all applicable regulatory requirements (PSD, NSR, NSPS, NESHAP, MACT, BACT, LAER) / YES / NO / N/A
* A demonstration that the source employs BAT / YES / NO / N/A
* An ambient air dispersion analysis, if applicable for PSD / YES / NO / N/A
* A demonstration of availability of ERCs, if needed / YES / NO / N/A
Section E, Compliance Documentation
* Monitoring, Testing, Reporting, Recordkeeping, if applicable / YES / NO / N/A
* Addendum A, Source Applicable Requirements
- Existing Title V Facilities (2700-PM-AQ0018 6/2003) / YES / NO / N/A
Section F, Flue and Contaminant Emission(s)
* Estimated emissions / YES / NO / N/A
* Stack and exhauster information / YES / NO / N/A
Section G, List of Attachments included / YES / NO / N/A

PSD – Prevention of Significant Deterioration LAER – Lowest Achievable Emission Rate

NSR – New source Review ERCs – Emission Reduction Credit

MACT – Maximum Achievable Control Technology NSPS – National Standards of Performance for New Stationary Sources

BACT – Best Available Control Technology NESHAP – National Emission Standards for Hazardous Air Pollutants