Form ECT-3 (Page 1)

Level of Activity Certification

(Title 30 Texas Administrative Code § 101.360)

I. COMPANY IDENTIFYING INFORMATION
A.Company Name:
B. Mailing Address
City: / State: / Zip Code:
Telephone: / Fax Number: / Email:
C. TCEQ Customer Identification Number:
D. Site Name:
Street Address (If no street address, give driving directions in writing):
E.Nearest City: / Zip Code: / County:
F.TCEQ Regulated Entity Number
G.TCEQ Account Number (if applicable):
II. SELLER’S TECHNICAL CONTACT INFORMATION
A. Contact Name: ( Mr. Ms. Dr.)
Contact Title:
Mailing Address:
City: / State: / Zip Code:
Telephone: / Fax Number: / Email:
III. LEVEL OF ACTIVITY CERTIFICATION
Facilities in operation prior to January 1, 1997, complete“Attachment A” by providingthe 1997, 1998, and 1999 Level of Activity for each FIN. New or modified facilities not in operation prior to January 1, 1997 that have not beenin operation for two consecutive complete calendar years, complete “Attachment A”by providing the throughput levels and emission rates authorized in the permit or permit by rule.New or modified facilities not in operation prior to January 1, 1997 that have been in operation two complete consecutive calendar years, complete “Attachment A” by providing the first two consecutive calendar years of actual historical data.
IV. CERTIFICATION
I, ______
[Name/Title - Please print or type]
state that I have knowledge of the facts herein set forth and that the same are true and correct to the best of my knowledge and belief. I further state that to the best of my knowledge and belief the information in this certification is not in any way in violation of 30 Texas Administrative Code §101.350 - 101.360 or any applicable air quality rule or regulation of the Texas Natural Resource Conservation Commission and that intentionally or knowingly making or causing to be made false material statements or representations in this certification is a CRIMINAL OFFENSE subject to criminal penalties.
DATE SIGNATURE ______
NOTE - ORIGINAL SIGNATURE IN INK IS REQUIRED.
FIN / FIN Name / Basis c / Authorization d / EPN / YEAR____
(units) _____ / YEAR____
(units) _____ / YEAR____
(units) _____
Level of Activity a / Emission Factor b / Level of Activity a / Emission Factor b / Level of Activity a / Emission Factor b

aLevel of Activity- e.g., heat input, fuel usage, flow rate, etc. Please provide units.

bProvide the Emission Factor measured for each unit during each respective year. All numbers represented in “Attachment A” should be supported with the appropriate documentation.

c Indicate whether emissions are based on allowable emissions (AL) , actual emissions (ACT), or extenuating circumstances (EXT) .

d Authorized by permit (P), grandfathered status (GF), or permit by rule (PBR). Please specify Permit No., permit by rule and/or registration number.

Mail application to:

Texas Commission on Environmental Quality

Emission Banking and Trading Program MC 206

POBOX 13087

AUSTIN, TX78711-3087

TCEQ-10386 (Rev. 12/07)

These forms are for use by the sources participating in the

Mass Emission Cap and Trade Program and are subject to revision. (NSRG: 7271v2)Page _____ of _____