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Certificate Of Representation 7610-1 - Official Federal Forms
| Certificate Of Representation Form. This is a national form and can be used in Air And Radiation Environmental Protection Agency (EPA) . |
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United States Environmental Protection Agency OMB Nos. 2060-0258, 2060-0570, and 2060-0667 Acid Rain, CAIR, and Transport Rule Trading Programs Approval Expires 07/31/2014 Certificate of Representation For more information, see instructions and 40 CFR 72.24, 96.113, 96.213, 96.313, 97.113, 97.213, 97.313, 97.416, 97.516, 97.616, 97.716, or a comparable state regulation, as applicable. This submission is: New Revised (revised submissions must be complete; see instructions) FACILITY (SOURCE) INFORMATION STEP 1 Provide information for the facility (source). Facility (Source) Name State Plant Code County Name Latitude Longitude STEP 2 Enter requested information for the designated representative. Name Title Company Name Mailing Address Phone Number Fax Number E-mail address STEP 3 Enter requested information for the alternate designated representative. Name Title Company Name Mailing Address Phone Number Fax Number E-mail address EPA Form 7610-1 (Revised 8-2011) American LegalNet, Inc. www.FormsWorkFlow.com Certificate of Representation Page 2 of 7 UNIT INFORMATION STEP 4: Complete a separate page 2 for each unit located at the facility identified in STEP 1 (i.e., for each boiler, simple cycle combustion turbine, or combined cycle combustion turbine) Do not list duct burners. Indicate each program to which the unit is subject, and enter all other unit-specific information. See instructions for more details. Applicable Program(s): Acid Rain TR NOx Annual CAIR NOX Annual TR NOx Ozone Season CAIR SO2 TR SO2 Annual CAIR NOX Ozone Season Acid Rain Nameplate Capacity (MWe) Generator ID Number (Maximum 8 characters) CAIR/Transport Rule Nameplate Capacity (MWe) Source Category Unit ID# Unit Type NAICS Code Is this unit located in Indian Country? If this is the first time the unit has been identified on the Certificate of Representation for this facility, was the unit moved from another facility? Check One: Check One: Yes No Date unit began (or will begin) serving any generator producing electricity for sale (including test generation) (mm/dd/yyyy): ): Check One: Projected Actual Yes No Company Name: Owner Operator Owner Operator Owner Operator Owner Operator Owner Operator Company Name: Company Name: Company Name: Company Name: EPA Form 7610-1 (Revised 8-2011) American LegalNet, Inc. www.FormsWorkFlow.com Certificate of Representation Page 3 of 7 STEP 5: Read the appropriate certification statements, sign, and date. Acid Rain Program I certify that I was selected as the designated representative or alternate designated representative (as applicable) by an agreement binding on the owners and operators of the affected source and each affected unit at the source (i.e., the source and each unit subject to the Acid Rain Program, as indicated in "Applicable Program(s)" in Step 4). I certify that I have all necessary authority to carry out my duties and responsibilities under the Acid Rain Program on behalf of the owners and operators of the affected source and each affected unit at the source and that each such owner and operator shall be fully bound by my representations, actions, inactions, or submissions. I certify that the owners and operators of the affected source and each affected unit at the source shall be bound by any order issued to me by the Administrator, the permitting authority, or a court regarding the source or unit. Where there are multiple holders of a legal or equitable title to, or a leasehold interest in, an affected unit, or where a utility or industrial customer purchases power from an affected unit under a life-of-the-unit, firm power contractual arrangement, I certify that: I have given a written notice of my selection as the designated representative or alternate designated representative (as applicable) and of the agreement by which I was selected to each owner and operator of the affected source and each affected unit at the source; and Allowances, and proceeds of transactions involving allowances, will be deemed to be held or distributed in proportion to each holder's legal, equitable, leasehold, or contractual reservation or entitlement, except that, if such multiple holders have expressly provided for a different distribution of allowances, allowances and proceeds of transactions involving allowances will be deemed to be held or distributed in accordance with the contract. Clean Air Interstate Rule (CAIR) NOX Annual Trading Program I certify that I was selected as the CAIR designated representative or alternate CAIR designated representative (as applicable), by an agreement binding on the owners and operators of the CAIR NOX source and each CAIR NOX unit at the source (i.e., the source and each unit subject to the CAIR NOX Annual Trading Program, as indicated in "Applicable Program(s)" in Step 4). I certify that I have all necessary authority to carry out my duties and responsibilities under the CAIR NOX Annual Trading Program on behalf of the owners and operators of the CAIR NOX source and each CAIR NOX unit at the source and that each such owner and operator shall be fully bound by my representations, actions, inactions, or submissions. I certify that the owners and operators of the CAIR NOX source and each CAIR NOX unit at the source shall be bound by any order issued to me by the Administrator, the permitting authority, or a court regarding the source or unit. Where there are multiple holders of a legal or equitable title to, or a leasehold interest in, a CAIR NOX unit, or where a utility or industrial customer purchases power from a CAIR NOX unit under a life-of-the-unit, firm power contractual arrangement, I certify that: I have given a written notice of my selection as the CAIR designated representative or alternate CAIR designated representative (as applicable) and of the agreement by which I was selected to each owner and operator of the CAIR NOX source and each CAIR NOX unit at the source; and CAIR NOX allowances and proceeds of transactions involving CAIR NOX allowances will be deemed to be held or distributed in proportion to each holder's legal, equitable, leasehold, or contractual reservation or entitlement, except that, if such multiple holders have expressly provided for a different distribution of CAIR NOX allowances by contract, CAIR NOX allowances and proceeds of transactions involving CAIR NOX allowances will be deemed to be held or distributed in accordance with the contract. EPA Form 7610-1 (Revised 8-2011) American LegalNet, Inc. www.Forms
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