South Coast Air Quality Management District, Form 500-F1 (2014.07)
Page 2 of 2
To complete this application, type or print the information in the appropriate blanks.
Section I - General Information
1. Facility Name: Provide the name of the legal entity that operates the facility.
AQMD Facility ID: Complete only if the facility has been issued a 6-digit identification or ID number by AQMD. If not, leave these boxes
blank. An ID number will be assigned when the application is submitted.
ORIS Code: Provide the 5-digit code that has been assigned to facility by Department of Energy.
2. Check all applicable boxes to indicate the type of Acid Rain application filed. If box 1a. is checked, complete Section II of this form. If
box 1b. is checked, complete and attach Form 500-F2 - Title IV Phase II Acid Rain Repowering Extension Plan. If box 1c. is checked,
complete and attach Form 500-F3 - Title IV Phase II Acid Rain New Unit Exemption Request. If box 1d. is checked, complete and attach
Form 500-F4 - Title IV Phase II Acid Rain Retired Unit Exemption Request.
3. Check one box that best represents the type of permit action requested. If box 1e. is checked, in the space provided identify any
additional elements regarding the application or the facility that need to be considered during the processing of this application (i.e., Initial
Title V Permit Application).
4. If the application is a revision request, describe in general terms the changes that are proposed in the application revision request.
Attach additional sheets as necessary.
Section II - Phase II Acid Rain Device Summary
1. Before completing this section, check one box to indicate whether this is a new application or a revision.
AQMD Device #:
Provide the identification number for each AQMD-assigned device subject to Phase II
requirements.
EPA Unit #:
Provide the identification number for each EPA-assigned device subject to Phase II
requirements.
Will device need a Repowering
Extension Plan?:
Indicate with a "yes" or "no" if the device is or will be participating under a Repowering
Extension Plan.
Has device started operations
on or
after 11/15/90?:
Indicate with a "yes" or "no" if the device was source tested or started operating on or after
November 15, 1990.
Device Operations Start Date:
Complete this column only
if the device was source tested or started operating on or after
November 15, 1990. Provide the date (mo/day/yr) when the device started or will start
operating. Note: If the date of beginning operations changes, an administrative permit revision
application will be required.
For Devices starting-up after
11/15/90,
provide date when Monitoring
Certification will begin:
Complete this column only
if the device was source tested or started operating on or after
November 15, 1990. Provide the date (mo/day/yr) when compliance with the monitoring
procedures for the device will begin. Refer to 40 CFR Part 75.4 to determine this date. Note:
If the monitoring certification date changes, an administrative permit revision application will be
required.
