Title V Permit Writer's Tips - Title V Permit Application Checklist Form

TITLE V PERMIT REVIEW PERMIT APPLICATION CHECKLIST STATE: ______ SOURCE NAME: ______________________________________ AFS Plant ID#_____________________(<16 characters) SOURCE TYPE: ______________________ PERMIT# ___________(<16 characters) SIC# ___________ SOURCE LOCATION (COUNTY ): __________________________ I. Is this a general permit? If yes, which one?_______________________ (Go to part III) If no, go to part II.
II. PROGRAM IMPLEMENTATION
Does this permit contain "streamlined limits" (per White Paper #2)	YES NO
Does this permit contain requirements/provisions for:
1. Periodic Monitoring	YES NO
2. NESHAP/MACT (If so, please list subpart(s)) _________________	YES NO
3. Case-by-case MACT	YES NO
4. NSPS (If so, please list subpart(s))____________________	YES NO
5. PSD/NSR	YES NO
6. Acid rain Phase II permit	YES NO
7. Potential-to-emit limits	YES NO
8. Consent order or agreement	YES NO
9. NOx RACT	YES NO
10. VOC RACT	YES NO
11. Does permit application contain confidential information	YES NO
III. COMPLIANCE STATUS
Is the source subject to a compliance schedule?	YES NO
IV. EPA REVIEW
1. Do you want EPA to review all or part of this permit?	YES NO
2. Are there other issues you would like to call to EPA's attention? Please explain.	YES NO
STATE CONTACT: ____________________________ DATE:___________ PHONE: ______________________
(for EPA use only) date entered _________ init ______ action ______ ver: 13sep96 cklst.app