PAL-04 Request For Termination Of Plantwide Applicability Limit {52454}

PAL-04: REQUEST FOR TERMINATION OF PLANTWIDE APPLICABILITY LIMIT State Form 52454 (11-05) IDEM - Office of Air Quality - Permits Branch 100 N. Senate Avenue Indianapolis, IN 46204 Telephone: (317) 233-0178 or Toll Free: 1-800-451-6027 x30178 (within Indiana) Facsimile Number: (317) 232-6749 http://www.IN.gov/idem/permits/air INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT NOTES: The purpose of this form is to request termination or revocation of an established Plantwide Applicability Limit (PAL). In order to complete your request in a timely manner, please do the following: · Attach this form to your completed application cover sheet and GSD-01. · Attach the current PAL permit. · Attach supplemental information behind this document. · Submit three copies of your completed request to the address in the upper right corner of this document. · Do NOT include any filing fee with the request. · Complete a separate request for each PAL termination request. IDEM makes all submitted information available to the public unless submitted under a claim of confidentiality. The applicant must make the claim of confidentiality at the time of submission following the requirements outlined in 326 IAC 17.1-4-1. Failure to follow these requirements exactly will result in your information becoming a public record, available for public inspection. PART A: Define the PAL Identify the date the current PAL permit was issued, the expiration date, the pollutant that this Plantwide Applicability Limit (PAL) addressed, and the proposed PAL Level. 1. Issuance Date of current PAL permit: 2. Expiration Date of current PAL permit: 3. Pollutant (choose one): 4. PAL Level (specify units): CO Pb NOx PM PM10 SO2 VOCPM2.5 PART B: Proposed Allowable Emission Limitations (Optional) Propose an allowable emission limitation for each emission units included in the previously issued PAL. If additional space is needed, you may make a copy of this table. 5. Emission Unit 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 6. PTE Designation (small / significant / major) 7. Proposed Allowable Emission Limitation (specify units) 8. Applicable Requirements Page 1 of 1 American LegalNet, Inc. www.FormsWorkflow.com