ÐÏࡱá > þÿ }  þÿÿÿ ^ _ ` a b c d e f g h i j k l m n o p q r s t u v w x y z { | € ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿì¥Á € ø¿ /, bjbj´V´V .\ Ö< Ö< ¼# r ÿÿ ÿÿ ÿÿ · a a a a a ÿÿÿÿ u u u 8 ­ É ¤ u o â m ( • ( ½ ½ ½ ñ ñ ñ Q ¢ ó! * a ñ ñ ñ ñ ñ a a ½ ½ 4 ) U U U ñ ¸ a ½ a ½ U ñ U U ’ Þ ½ ÿÿÿÿ p0q¹d¨Ë u © Ž ª þ ? 0 o ² , " 7 " Þ " a Þ ñ ñ U ñ ñ ñ ñ ñ U ñ ñ ñ o ñ ñ ñ ñ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ ÿÿÿÿ " ñ ñ ñ ñ ñ ñ ñ ñ ñ ' : INSTRUCTIONS FOR COMPLETING THE TITLE V ANNUAL COMPLIANCE CERTIFICATION FORM Information required to be included in the Annual Compliance Certification is located at OKLAHOMA ADMINISTRATIVE CODE (OAC), Air Pollution Control, Title 252, Chapter 100-8-6(c)(5)(C)(i-v). PART 1 - IDENTIFYING INFORMATION Company and Facility Name Company and facility name as printed on the cover of the permit. Principal Facility Product The primary type of activity conducted by the facility and SIC/NAICS and/or product produced with associated SIC/NAICS code (visit HYPERLINK "http://www.osha.gov"www.osha.gov or HYPERLINK "http://www.census.gov"www.census.gov for additional information). Physical Address The physical location of the facility. Mailing Address Address where the facility receives mail. Initial Title V Permit Number Number of the initial Title V permit issued to the facility. Issuance Date Date that the initial Title V permit was issued to the facility, as indicated by the date of the signature of the DEQ permitting authority. This date is used to determine the Annual Compliance Certification cycle and due date unless otherwise permitted by DEQ. Permit Modification and/or When applicable, list permit numbers for all Title V Renewal Number(s) permits, amendments, and other permit changes that were federally enforceable (issued) during the reporting period including construction permit conditions. Permit Modification and/or When applicable, issuance date for each permit listed Renewal Issuance Date(s) in the previous data field. Certification Period Beginning and ending dates for the reporting period covered by this form, normally encompassing a full year. If the facility’s Title V permit is cancelled during the reporting period, certification must be made for the time in which the Title V permit was effective. The certification is due no later than 30 days after each anniversary date of the issuance of the initial Title V permit unless otherwise permitted by DEQ. Environmental Contact Person The environmental contact should be a person familiar with the day-to-day operation of the facility and should be available to be contacted by DEQ personnel. The appropriate contact information should be provided. Responsible Official The definition of “responsible official” is specified in 40 C.F.R. § 70.2 and OAC 252:100-1-3, and is generally summarized as: For a Corporation: Corporate Officer, Other person in charge of principal business functions, or Duly authorized representative responsible for overall operation of a source (i.e. Plant Manager) if either: Facility employs more than 250 persons or has $25 million in sales or expenditures, or Delegation of authority is approved in advance by DEQ For a partnership or sole proprietorship: A general partner, or The proprietor, respectively For a public agency: Principal executive officer, or Ranking elected official Appropriate contact information should be provided. PART 2 – CERTIFICATION OF TRUTH, ACCURACY, AND COMPLETENESS A responsible official must print their name, sign, and date the certification of truth, accuracy, and completeness using blue or black ink. A title must be included to ensure that the signing party meets the criteria for responsible official as described above. A copy of the certification that includes the original signature of the responsible official must be provided to DEQ. PART 3 – ANNUAL COMPLIANCE CERTIFICATION DATA Use the table to report the compliance status and methods or means used to determine compliance with each federally enforceable permit term and condition effective during the certification period. Those conditions that do not impose any affirmative compliance obligations on the permit holder are not required to be included unless the source has had to take action in reference to them (i.e. Permit Shield, authorization to operate continuously, etc.). Copy the table provided as many times as necessary to cover all applicable permit terms and conditions. [A] Condition Identification All federally enforceable permit terms and conditions effective during the certification period should be identified under column [A]. [1] Permit Number and Condition Number List the permit number and condition number for each permit term effective during the certification period. For permit modifications and renewals with conditions that are the same as previous Title V permits also effective during the certification period, the same certification line may be shared as illustrated in the following example (Table 1). Table 1. Permit Condition Identification Example [A] Condition Identification[1] Permit and Condition Number[2] Applicable Requirement2010-000-TV SpC 3 2010-000-TVR SpC 3Fuel-burning equipment shall be fired with natural gas [2] Applicable Requirement Briefly describe the requirement of each condition. If the requirement is expressed as a numerical limitation or range of values, the description should identify the limit. It is not necessary to copy the conditions verbatim into the table. [B] Compliance Determination Method(s), Information, and/or Facts Identify the method(s) used for determining the compliance status of the source during the certification period. If a source becomes aware of information that indicates a deviation from permit terms or an applicable requirement, even though the permit does not specifically require the information, the source must consider the information, identify and address it in the compliance certification, and certify accordingly. DEQ has included a list of monitoring codes for your convenience (see Table 2 below). The regulated community can use other monitoring codes if the codes used are explained. If the source wishes to explain the method in narrative, they may choose to do so. Table 2. Monitoring Code Table Monitoring CodeShort DescriptionExample ActivitiesBMPBest Management Practice-Practices generally recognized as “good operational practice” or published as “best management practice”CEMSContinuous Emission Monitoring System-Continuous Emission Monitoring SystemCERMSContinuous Emission Rate Monitoring System-Sulfuric acid plantsCOMSContinuous Opacity Monitoring System-Continuous Opacity Monitoring SystemOMPOperations and Maintenance Plan-Operate equipment in accordance with manufacturer’s recommendations -Periodic replacement of paint booth filtersPEMSPredictive Emissions Monitoring System-Predictive NOx monitorPMSParametric Monitoring System-Record thermal oxidizer operating temperature -Record baghouse pressure drop -Record scrubber flow rate and pHRRRecordkeeping Requirement-By-delivery fuel certification -Track pollutant content (e.g., VOC, HAP) -Calculate rolling emissions totalSTStack Test-Testing using EPA approved methodVEVisible Emissions Monitoring-Daily visible emissions check -Periodic Method 9 observationsVINVisual Inspection-Periodic inspection of work practices [C] Compliance Status Identify either “Continuous” or “Intermittent” compliance status with respect to each permit condition during the certification period as determined using the method or means indicated. PART 4 – STANDARD CONDITIONS COMPLIANCE CERTIFICATION [1] Standard Conditions Identification Indicate which version(s) of the Standard Conditions were issued with each Title V permit enforceable during the certification period by typing the Standard Condition effective dates. [2] Compliance Certification If continuous compliance with all Standard Conditions enforceable during the certification period was achieved, check the first box. If compliance was intermittent for any of the Standard Conditions, check the second box and list the condition(s) in the table. **If the source experienced intermittent compliance for any permit term or condition during the certification period, the source should consider their compliance status with Standard Condition Section I. Duty to Comply.** PART 5 – DEVIATION REPORTING Identify the status of any deviations that occurred during the certification period identified in Part 3 and Part 4, indicating “Yes” or “No” as to whether any of the deviations have been previously reported (or identified by DEQ) and whether any of the deviations have not been previously reported (or identified by DEQ). Table 1 and Table 2: Deviation Summary and Deviation Details Complete Table 1 for previously reported deviations with information used to determine the duration and extent of the deviation(s) reported and/or incorporate deviation reports by reference. Complete Table 2 for previously unreported deviations with information to determine the duration and extent of the deviation(s) reported. Please mail an Annual Compliance Certification (DEQ Form 100-924) to each of the following addresses: Department of Environmental Quality Attn: Air Quality Division Director 707 N. Robinson P.O. 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