Fillable Application Submittal (Maricopa County Telecommunications)

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Application Submittal (Maricopa County Telecommunications)

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Revised 19 May 2020
Maricopa County Air Quality Department
3800 N. Central Ave., Suite 1400, Phoenix, AZ 85012
Phone: 602-506-6010 Fax: 602-372-0587
AQPermits@maricopa.gov
NON-TITLE V PERMIT MINOR MODIFICATION APPLICATION
Application Submittal
Applications may be submitted in person or mailed to either of the following locations:
1. Maricopa County Air Quality Department, 3800 N. Central Ave., Suite 1400, Phoenix, AZ 85012
2. One Stop Shop, 501 N. 44th St., Suite 200, Phoenix, AZ 85008
A $200.00 application fee must be submitted along with the required documents. Checks may be made payable to the Maricopa County
Air Quality Department (MCAQD). Before the permit can be issued, the applicant will also be billed for all permit processing time
required for a billable permit action at a rate of $155.80 per hour, adjusted annually under Maricopa County Air Pollution Control
Regulations, rule 280. An annual administrative fee will also be charged per rule 280.
Submit this application prior to making modifications. Per rule 220, section 405, and section 406, this application must be submitted for a
currently permitted facility requesting a minor permit revision. This notification is not required for changes in work schedules or
relocation of equipment for similar use within a permitted facility.
Once submitted, the application and documents become property of MCAQD and will not be returned. All submitted documents will be
available to the public unless a notice of confidentiality is submitted by the applicant in accordance with Arizona Revised Statutes (ARS)
§49-487 and accepted by MCAQD in accordance with Maricopa County Air Pollution Control Regulations, rules 100, and 200.
Facility Information
Facility Name:
Mailing Address:
Facility ID:
City: State: Zip:
Phone Number:
On-Site Operator Contact Information
Name: Email:
Phone Number:
City: State: Zip:
Mailing Address:
Company Name: Job Title:
Mobile Phone Number:
Permitting Contact Information
Name: Email:
Phone Number:
City: State: Zip:
Mailing Address:
Company Name: Job Title:
Mobile Phone Number:
Revised 19 May 2020
Maricopa County Air Quality Department
3800 N. Central Ave., Suite 1400, Phoenix, AZ 85012
Phone: 602-506-6010 Fax: 602-372-0587
AQPermits@maricopa.gov
NON-TITLE V PERMIT MINOR MODIFICATION APPLICATION
Authorized Contact Regarding the Application
Name: Email:
Phone Number:
City: State: Zip:
Mailing Address:
Company Name: Job Title:
Mobile Phone Number:
Notice of Regulatory Reform
In accordance with A.R.S. §11-1604:
A. A county shall not base a licensing decision in whole or in part on a licensing requirement or condition that is not specifically
authorized by statute, rule, ordinance or delegation agreement. A general grant of authority does not constitute a basis for imposing a
licensing requirement or condition unless the authority specifically authorizes the requirement or condition.
B. Unless specifically authorized, a county shall avoid duplication of other laws that do not enhance regulatory clarity and shall avoid dual
permitting to the maximum extent practicable.
C. This section does not prohibit county flexibility to issue licenses or adopt ordinances or codes.
D. A county shall not request or initiate discussions with a person about waiving that person's rights.
E. This section may be enforced in a private civil action and relief may be awarded against a county. The court may award reasonable
attorney fees, damages and all fees associated with the license application to a party that prevails in an action against a county for a
violation of this section.
F. A county employee may not intentionally or knowingly violate this section. A violation of this section is cause for disciplinary action or
dismissal pursuant to the county's adopted personnel policy.
G. This section does not abrogate the immunity provided by section 12-820.01 or 12-820.02.
As an official representative of the company, I certify that I am familiar with the operations and equipment represented on this application
and corresponding attachments, and the information provided herein is true and accurate to the best of my knowledge.
Signature: Date:
Print Name: Title:
1. Narrative description of the proposed modification:
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Revised 19 May 2020
Maricopa County Air Quality Department
3800 N. Central Ave., Suite 1400, Phoenix, AZ 85012
Phone: 602-506-6010 Fax: 602-372-0587
AQPermits@maricopa.gov
NON-TITLE V PERMIT MINOR MODIFICATION APPLICATION
2. Provide a list of equipment and emission control devices that will be installed or modified. Attach a separate sheet with
additional equipment and emission control devices if necessary.
Assigned
Equipment
Number
Describe Each Piece of Equipment
Include Make & Model
Date of
Installation
or
Modification
How
Many
HP, KVA, Gallons or
Other Ratings
(Specify Units)
Exhaust -
Vent to Air
Exhaust -
Vent to Control
(Identify)
3. List all materials handled, stored, processed, used, mixed, treated, or emitted. Include chemicals, mixtures, resins, cleaning
compounds, etc., in this list. Identify each in sufficient detail and attach material safety data sheets (MSDS). Attach a separate
sheet with additional materials if necessary.
Material Annual Usage or Throughput
Chemical Composition
(% by weight)
Equipment
Number in
Which Used
4. Describe control devices:
Type of Device Name/ID Gas Flow Rate SCFW
Liquid Flow
Rate Gal/Min
Control
Efficiency
(% Weight)
5. Materials reclaimed or shipped as waste:
6. Air Pollutant Emissions (complete this section if applicable.)
Provide a summary of the projected actual air emissions on an annual basis for the entire site in the following three columns:
(i) Emissions to be released from only the equipment and affected processes described on this application.
(ii) The entire site prior to the modification of the equipment and processes described in (i) above.
(iii) The entire site including the emissions identified in (i) above. Normally, this column will be the sum of columns (i) and (ii).
Revised 19 May 2020
Maricopa County Air Quality Department
3800 N. Central Ave., Suite 1400, Phoenix, AZ 85012
Phone: 602-506-6010 Fax: 602-372-0587
AQPermits@maricopa.gov
NON-TITLE V PERMIT MINOR MODIFICATION APPLICATION
Pollutant Column (i) Column (ii) Column (iii)
Carbon Monoxide (CO)
Oxides of Nitrogen (NOx)
Oxides of Sulfur (SOx)
Particulates of 10 Microns or Smaller (PM
10
)
Total Suspended Particulates (TSP), Including PM
10
Volatile Organic Compounds (VOCs*)
*VOCs defined by the EPA
Federal hazardous air pollutants: list each one separately, attach a separate sheet if necessary
See the Federal Hazardous Air Pollutants List for a complete list
Attach detailed calculations to support the figures in the above summary tables. If supporting calculations are not included with the
application, the application will be deemed incomplete. Do not include the emissions from motor vehicles. Include the emissions
from stationary sources, portable sources, test areas, experimental facilities, evaporative losses, storage and handling losses, fuel loading
and unloading losses, etc. Specifically identify the following in detailed calculations:
1. Emissions From Each Point Source And Each Stack 4. Overall Efficiencies
2. Capture Efficiencies 5. Fugitive Emissions
3. Control Efficiencies 6. Non-point (area) Emissions
For particulate (dust) emissions, describe the types of particulates being emitted and the quantities of emissions for each type. Identify and
quantify each and every type of VOC that is included in the above summary tables. Whenever a material is identified by a trade name, also
provide its generic name and its chemical abstract service (CAS) number. Help sheets for calculating emissions from specific industries or
processes can be obtained at Maricopa.gov/4151. If you need assistance completing the application, contact MCAQD at 602-506-6010.
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Application Submittal (Maricopa County Telecommunications)

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Completed 6 August 2020

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