Scp-01: Submittal Cover Page Permit Application/Notification




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SCP-01: Submittal Cover Page

Permit Application/Notification/


Determination Request Fee Submittal

Air Quality Permit Program



Doc Type: Permit Application

Instructions on Page 7

1a) AQ Facility ID number:

     

1b) Agency Interest ID number:

     

2) Facility name:

     

3) Submittal is (choose from the following options and then complete the remainder of item 3 as directed):

 The final certified (or recertified) version of a previously-submitted permit application. Complete Section 3A.

 Additional or supplemental information requested by permit staff during the permit-writing process. Complete Section 3A.

 A request that the Minnesota Pollution Control Agency (MPCA) make an applicability determination. Complete Section 3A.

 An application for a new individual Part 70 or State permit – choose one of the following:

 This is the original application or replacement for a denied application – Complete Section 3B.

 This is the replacement for an application returned as incomplete (not denied) and the scope is different than the incomplete application – Complete Section 3B.

 This is the replacement for an application returned as incomplete (not denied) and the scope is exactly the same as in the incomplete application – Complete Section 3E.

 An application for reissuance of an individual Part 70 or State permit – choose one of the following:

 This is the original application or replacement for a denied application – Complete Section 3B.

 This is the replacement for an application returned as incomplete (not denied) and the scope is different than the incomplete application – Complete Section 3B.

 This is the replacement for an application returned as incomplete (not denied) and the scope is exactly the same as in the incomplete application – Complete Section 3B.

 An application for an amendment to an existing individual Part 70 or State permit – choose one of the following:

 This is the original application or replacement for a denied application – Complete Section 3B.

 This is the replacement for an application returned as incomplete (not denied) and the scope is different than the incomplete application – Complete Section 3B.

 This is the replacement for an application returned as incomplete (not denied) and the scope is exactly the same as in the incomplete application – Complete Section 3E.

 An application for a registration permit, capped permit, or general permit – choose one of the following:

 This is the original application or replacement for a denied application – Complete Section 3C.

 This is the replacement for an application returned as incomplete (not denied) and the scope is different than the incomplete application – Complete Section 3C.

 This is the replacement for an application returned as incomplete (not denied) and the scope is exactly the same as in the incomplete application – Complete Section 3E.

 An application for an administrative change to an existing registration, capped, or general permit – choose one of the following:

 This is the original application or replacement for a denied application – Complete Section 3C.

 This is the replacement for an application returned as incomplete (not denied) and the scope is different than the incomplete application – Complete Section 3C.

 This is the replacement for an application returned as incomplete (not denied) and the scope is exactly the same as in the incomplete application – Complete Section 3E.

 A notification required under Minn. R. 7007.1150(C); Minn. R. 7007.1250, subp. 4; Minn. R. 7007.1350; Minn. R. 7007.1110, subp. 10, 11, or 11a; or Minn. R. 7007.1146, subp. 2(G). Complete Section 3D.

 A notification from a hot mix asphalt plant holding a registration permit of the intent to incorporate ground tear-off shingles and/or manufacturer scrap shingles in the hot mix asphalt. Complete Section 3D.



Section 3A – Request for applicability determination, recertification of a previously-submitted permit application, or supplement to a previously-submitted permit application

Use this section only if your submittal is one of the following:



  • The final version of a previously submitted permit application, incorporating changes negotiated through the permitting process, or

  • Submittal of additional or supplemental information requested by permit staff during the permit-writing process, or

  • A request for the MPCA to make an applicability determination.

For final versions and supplemental information, enter the “tracking number” which can be obtained from the MPCA permit staff working on the permit.

Check one of the boxes below. Do not complete Sections 3B, 3C, 3D, or 3E. Continue with item 4 of the form.



Choose one of the following:

Quantity

Points

Total points

 Recertification of a previously-submitted permit application – Tracking No:      

NA

NA

NA

 Supplement to a previously-submitted permit application – Tracking No:      

NA

NA

NA

 An Applicability Determination Request

     

x 10 =

     




Section 3B – Application for an individual Part 70 or State permit, reissuance of an individual Part 70 or State permit, or amendment of an individual Part 70 or State permit

Is this application replacing an application that was returned as incomplete (not an application that was denied)?

 No  Yes Enter the Tracking Number of the incomplete application being replaced:      .

Check as many of the boxes below as apply. If your submittal also includes notifications that do not require a permit application, also complete Section 3D. Then continue with item 4 of the form.



Choose one of the following:

Quantity

Points

Total points

 Application for an individual Part 70 permit

     

x 75 =

     

 Application for an individual State permit

     

x 50 =

     

 Application for reissuance of an expiring individual Part 70 or state permit










Expiration date:

     

Application due date (180 days prior to expiration):

     

NA

NA

NA

(mm/dd/yyyy) (mm/dd/yyyy)










 Application for a major amendment to an individual State or Part 70 permit

 Includes reconstruction or modification of a New Source Performance Standards (NSPS) Affected Facility not subject to New Source Review



     

x 25 =

     

 Application for a moderate amendment to an individual State or Part 70 permit

     

x 15 =

     

 Application for a minor amendment to an individual State or Part 70 permit

     

x 4 =

     

 Application for an administrative amendment to an individual State or Part 70 permit

     

x 1 =

     

Additional information (check all that apply):

 Submittal was preceded by pre-application work with the MPCA (for example: dispersion modeling or modeling protocol review, AERA review, environmental review). The tracking number associated with the preapplication work is:      

 Permit will replace an existing permit of a different type (e.g., replacing a Capped Permit with an individual State permit, or replacing a Part 70 General permit with an individual Part 70 permit).

 Permit is for construction of a new facility.

 Permit is required because of a modification to an existing facility, making the facility subject for the first time for the requirement for an air emission permit.

 Project is subject to Prevention of Significant Deterioration (PSD) (40 CFR § 52.21)

  • Send a complete copy of the application to U.S. Environmental Protection Agency (EPA) Region V (see instructions).

  • Contact EPA Region V to begin the Endangered Species Assessment process (see instructions).

 Permit is required because of installation or modification of a Part 61 National Emission Standards for Hazardous Air Pollutants (NESHAP) and/or a Part 60 NSPS Affected Facility at a Stationary Source with Potential-to-Emit below all permit thresholds (Minn. R. 7007.0500, subp. 2.C.(1)).



Section 3C – Application for a registration, capped, or general permit

Is this application replacing an application that was returned as incomplete (not an application that was denied)?

 No  Yes Enter the tracking number of the incomplete application being replaced:      .

Check as many of the boxes below as apply. Continue with item 4 of the form.



Choose one of the following:

Quantity

Points

Total Points

 Application for a registration permit

 Option A  Option B  Option C  Option D



     

x 2 =

     

 Application for a capped permit

 Option 1  Option 2



     

x 4 =

     

 Application for a Part 70 general permit

 Manufacturing General Permit  Low Emitting Facility General Permit



     

x 4 =

     

 Application for a State general permit

 Nonmetallic Mineral Processing General Permit



     

x 3 =

     

 Application for an administrative change to an existing registration, capped, or general permit (e.g., change of facility ownership)

     

x 1 =

     

Additional information (check all that apply):

 Permit will replace an existing permit of a different type (e.g., replacing a registration permit with a capped permit; replacing an option B registration permit with an option D registration permit; etc.)

 Permit is required for construction of a new facility

 Permit is required because of a modification to an existing facility, making the facility subject for the first time for the requirement for an air emission permit.

 Permit is required because of a modification or change making the facility ineligible for its existing air emission permit.




Section 3D – Notifications

If your submittal also includes a permit application, then also complete Section 3A, 3B, 3C, or 3e as applicable. Check all applicable boxes below, then continue with item 4 of the form.

 A Notification of Accumulated Insignificant Activities (Minn. R .7007.1250, subp. 4)

 A Notification of Installation of Pollution Control Equipment (Minn. R. 7007.1150, item C)

 A Notification of Replacement of a Unit (Minn. R. 7007.1150, item C)

 A Notification of Replacement of Controls with Listed Controls (Minn. R. 7007.1150, item C)

 A Notification of Changes That Contravene a Permit Term (Minn. R .7007.1350)

 A Notification of Applicability of a New NSPS (applies to Capped Permits) (Minn. R. 7007.1146, subp. 2(G))

 A Notification of Applicability of a New NSPS (applies to Registration Permits) (Minn. R. 7007.1110, subp. 10)

 A Notification of Changes (not Modifications) Causing a New Permit to be Needed (applies to Registration Permits)


(Minn. R. 7007.1110, subp. 11)

 A Notification of a Regulatory Change Causing a New Permit to be Needed (applies to Registration Permits)


(Minn. R. 7007.1110, subp. 11a)

 A Notification From a Hot Mix Asphalt Plant Including a Request to Incorporate Ground Tear-off Shingles and/or Manufacturer Scrap Shingles in the Hot Mix Asphalt (applies to Registration Permits) Minn. R. 7011.0913, subp. 3)






Section 3E – Replacement for an incomplete application where the project scope is unchanged

Enter the Tracking Number of the incomplete application being replaced:      .

Check one option under “i" and one option under “ii”. Calculate the points’ difference in “iii”. Check all that apply under “iv.” Then continue with item 4 of the form.





  1. Choose one of the following describing this application:

Quantity

Points

Total Points

 Application for an individual Part 70 permit

     

x 75 =

     

 Application for an individual State permit

     

x 50 =

     

 Application for a major amendment to an individual State or Part 70 permit

 Includes reconstruction or modification of a New Source Performance


Standards (NSPS) Affected Facility not subject to New Source Review

     

x 25 =

     

 Application for a moderate amendment to an individual State or Part 70 permit

     

x 15 =

     

 Application for a minor amendment to an individual State or Part 70 permit

     

x 4 =

     

 Application for an administrative amendment to an individual State or Part 70 permit

     

x 1 =

     

 Application for a registration permit

 Option A  Option B  Option C  Option D



     

x 2 =

     

 Application for a Capped Permit  Option 1  Option 2

     

x 4 =

     

 Application for a Part 70 general permit

 Manufacturing general permit  Low emitting facility general permit



     

x 4 =

     

 Application for a State general permit

 Nonmetallic mineral processing general permit



     

x 3 =

     

 Application for an administrative change to an existing registration, capped, or general permit (e.g., change of facility ownership)

     

x 1 =

     

  1. Choose one of the following describing the incomplete application being replaced:

Quantity

Points

Total Points

 Application for an individual Part 70 permit

     

x 75 =

     

 Application for an individual State permit

     

x 50 =

     

 Application for a major amendment to an individual State or Part 70 permit

     

x 25 =

     

 Application for a moderate amendment to an individual State or Part 70 permit

     

x 15 =

     

 Application for a minor amendment to an individual State or Part 70 permit

     

x 4 =

     

 Application for an administrative amendment to an individual State or Part 70 permit

     

x 1 =

     

 Application for a registration permit

 Option A  Option B  Option C  Option D



     

x 2 =

     

 Application for a capped permit  Option 1  Option 2

     

x 4 =

     

 Application for a Part 70 general permit

 Manufacturing general permit  Low emitting facility general permit



     

x 4 =

     

 Application for a State general permit

 Nonmetallic mineral processing general permit



     

x 3 =

     

 Application for an administrative change to an existing registration, capped, or general permit (e.g., change of facility ownership)

     

x 1 =

     

  1. (Points from part i:      ) – (Points from part ii:      ) = Total points for Section 3E.

If the number is negative (e.g., the number from “ii” is larger than the number from “i',
enter “0”.


     

  1. Additional information (check all that apply):

 Submittal was preceded by pre-application work with the MPCA (for example: dispersion modeling or modeling protocol review, AERA review, environmental review). The tracking number associated with the preapplication work is:      

 Permit will replace an existing permit of a different type (e.g., replacing a capped permit with an individual State permit, or replacing a Part 70 general permit with an individual Part 70 permit)

 Permit is for construction of a new facility.

 Permit is required because of a modification to an existing facility, making the facility subject for the first time for the requirement for an air emission permit.

 Project is subject to Prevention of Significant Deterioration (PSD) (40 CFR § 52.21)

  • Send a complete copy of the application to U.S. Environmental Protection Agency (EPA) Region V (see instructions).

  • Contact EPA Region V to begin the Endangered Species Assessment and Historic Preservation Act processes (see instructions).

 Permit is required because of installation or modification of a Part 61 National Emission Standards for Hazardous Air Pollutants (NESHAP) and/or a Part 60 NSPS Affected Facility at a Stationary Source with Potential-to-Emit below all permit thresholds (Minn. R. 7007.0500, subp. 2.C.(1)).




4) Total points ( “total points” from Section 3A, 3B, 3C, or 3E part iii)

     

5) Total application fee

     

x $285 =

$      




(total points from item 4)




(fee amount)

The application fee amount is $285 per point, payable to the MPCA. Send your payment (“fee amount”) with your submittal.
The fee is not refundable, per Minn. R. 7002.0016, subp. 1. There may be additional fees assessed during processing of your request, as required by Minn. R. ch. 7002.

6a) Confidentiality statement:

 This application does not contain material claimed to be confidential under Minn. Stat. §§ 13.37 subd. 1(b) and 116.075. Skip item 6b, go to item 7.

 This application contains material which is claimed to be confidential under Minn. Stat. §§ 13.37 subd. 1(b) and 116.075. Complete Item 6b. Your submittal must include both Confidential and Public versions of your application.

Registration permit applicants may not claim any portion of their application as confidential. If applying for a registration permit or an administrative change to a registration permit, you must check the first box above
(“This application does not contain…..”).

 Confidential copy of application attached  Public copy of application attached



6b) Confidentiality certification

To certify data for the confidential use of the MPCA, a responsible official must read the following, certify to its truth by filling in the signature block on the following page, and provide the stated attachments.

 I certify that the enclosed permit application(s) and all attachments have been reviewed by me and do contain confidential material. I understand that only specific data can be considered confidential and not the entire application or permit. I certify that I have enclosed the following to comply with the proper procedure for confidential material:

 I have enclosed a statement identifying which data contained in my application I consider confidential, and I have explained why I believe the information qualifies for confidential (or non-public) treatment under Minnesota Statutes.

 I have explained why the data for which I am seeking confidential treatment should not be considered “emissions data” which the MPCA is required to make available to the public under federal law.

 I have enclosed an application containing all pertinent information to allow for completion and issuance of my permit. This document has been clearly marked “confidential”.

 I have enclosed a second copy of my application with the confidential data blacked out (not omitted or deleted entirely). It is evident from this copy that information was there, but that it is not for public review. This document has been clearly marked “public copy”.


Permittee responsible official:

Co-Permittee responsible official (if applicable)

Mr./Ms.

     

Mr./Ms.

     

Title:

     

Title:

     

Signature:




Signature:




Date:

     

Date:

     

7) Submittal certification

I certify under penalty of law that the enclosed documents and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.

I also certify, in accordance with Minn. R. 7007.0500, subp. 2 (K)(2) and subp. 2 (K)(3), that I have reviewed the procedures implemented by my facility to maintain compliance and that those procedures are, to the best of my knowledge and belief, reasonable to maintain compliance with all applicable requirements, including those that will become applicable during the term of the permit.

I also certify, in accordance with Minn. R. 7007.1450, subp. 4(D), that if this application requests the use of the minor or moderate permit amendment procedures, the proposed change is not part of a larger project which, taken as a whole, would not qualify for treatment as a minor or moderate permit amendment.

Choose one of the following:

 I certify that no construction is associated with the permit action sought by this permit application.

 I certify that my project includes construction, but construction has not yet been started except as allowed under Minn. R. 7007.1110, subp. 10 or Minn. R. 7007.1250, subp. 4, and will not begin until the permit is issued except as allowed under Minn. R. 7007.1110, subp. 12; Minn. R. 7007.1142, subp. 2; Minn. R. 7007.1150, item C; or Minn. R. 7007.1450, subp. 7.

 My project includes construction, and construction other than what is allowed under Minnesota Rules has been started



Permittee responsible official:

Co-Permittee responsible official (if applicable)

Mr./Ms.

     

Mr./Ms.

     

Title:

     

Title:

     

Signature:




Signature:




Date:

     

Date:

     

8) Package submittal
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