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OAQ FEDERAL RULE INCORPORATION APPLICATION FED-03: Compliance Assurance Monitoring (CAM)
State Form 53377 (9-07)

IDEM ­ Office of Air Quality ­ Permits Branch 100 N. Senate Avenue, MC 61-53 Indianapolis, IN 46204 Telephone: (317) 233-0178 or Toll Free: 1-800-451-6027 x30178 (within Indiana) Facsimile Number: (317) 232-6749 www.IN.gov/idem/permits/air/index.html

INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT

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The purpose of this form is to obtain detailed information about the monitoring protocol that is proposed to satisfy the federal requirements for Compliance Assurance Monitoring (CAM) under 40 CFR Part 64. Complete one form for each emission unit (or group of identical emission units) ­ pollutant combination that is subject to the same CAM requirements. Detailed instructions for this form are available online at www.in.gov/idem/permits/air/apps/instructions/fed03instructions.html. All information submitted to IDEM will be made available to the public unless it is submitted under a claim of confidentiality. Claims of confidentiality must be made at the time the information is submitted to IDEM, and must follow the requirements set out in 326 IAC 17.1-4-1. Failure to follow these requirements exactly will result in your information becoming a public record, available for any one to inspect and photocopy.

PART A: Emission Unit Summary Part A identifies and describes the process unit the pollutant of concern, and the applicable requirement. 1. Unit ID: 3. Description: 2. Installation Date:
(actual or anticipated)

4. Pollutant of Concern:

CO

Pb

NOx

O3

PM

PM10

PM2.5

SO2

VOC

Other (specify):

5. Add-On Control Technology: Identify all control technologies used for this unit, and attach completed CE-01 (unless "none"). None Baghouse / Fabric Filter ­ Attach CE-02. Electrostatic Precipitator ­ Attach CE-04. Oxidizer / Incinerator ­ Attach CE-06. Condenser ­ Attach CE-08. Other ­ Attach CE-10. (specify): 6. Applicable Requirement: Provide the regulatory reference (rule citation) and a brief summary of the requirement. Attach additional information if necessary. Cyclone ­ Attach CE-03. Absorption / Wet Collector / Scrubber ­ Attach CE-05. Adsorber ­ Attach CE-07. Reduction ­ Attach CE-09.

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Indiana Department Of Environmental Management Office Of Air Quality State Form 53377 (9-07)

Compliance Assurance Monitoring (CAM) FORM FED-03 Page 2 of 2

PART B: Monitoring Parameters Part B identifies and describes the monitoring parameters that will satisfy CAM requirements. 7. Monitoring Determination Method: (check all that apply) Actual emissions Predicted emissions Process parameter(s): (specify) Control device parameter(s) (specify) Inspection and maintenance activities (specify) 8. Indicator Range, Ranges, or Operating Condition: If unknown at this time, specify procedure for establishing values. Value (specify units): Basis: Source Test Manufacturer's Design Criteria Other (specify): Engineering Assessment Statistical Analysis Of Existing Data

For indicators based on a source test, has the emissions unit and/or control device been changed since the test that was used to establish the value? Yes Procedure: Test Plan: Testing Schedule: 9. Monitoring Performance Criteria: Location of Monitoring Device(s): Installation Specifications: Quality Assurance or Quality Control (QA/QC): Data Averaging Period: Frequency of Data Collection: PART C: Justification Part C provides a justification for the monitoring that is proposed as CAM. 10. Justification: Provide a brief justification of how the monitoring plan listed above satisfies CAM requirements. No

11. Will the proposed CAM be operational when the permit is issued? If "no", explain why the proposed CAM will not be operational when the permit is issued. Yes Reason: Implementation schedule: No