Fillable Form Ice (Bay Area Air Quality Management District)

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Form Ice (Bay Area Air Quality Management District)

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Continued on reverse side Page 1 of 2
Form ICE Rev 09/18/19
Pollutant Name
Wt %
Reduction
Basis
Code
Particulates
Organics
Nitrogen Oxides
Sulfur Dioxide
Carbon Monoxide
Others
Check here and attach a
separate list of pollutants. Include the basis
code and the control
efficiency.
BAY AREA AIR QUALITY MANAGEMENT DISTRICT
Form ICE
375 Beale Street, Suite 600, San Francisco, CA 94105
Internal Combustion Engines
Phone
(415) 749-4990
Application#
(BAAQMD Only)
www.baaqmd.gov
Email
permits@baaqmd.gov
Form ICE is to be completed for all internal combustion engines except turbines. (For turbines, submit Form C). Submit one form for
each engine. If this is a new engine or a modification to an existing engine, complete Form HRA (Health Risk Assessment).
Please include the engine manufacturer’s equipment specifications as an attachment to this form.
Facility Name _______________________________________ Plant/Facility No. ______________ Source No. (Existing Only)
Source Description Initial Date of Operation (New Engines Only)
Operating Schedule: Typical hrs/day Days/week Weeks/yr Maximum hrs/day
Engine Type: (Check one) 4 Stroke 2 Stroke Compression Ignition (Diesel) or 4 Stroke 2 Stroke Spark Ignition
Engine Manufacturer Model Model Year
EPA/CARB Engine Family Name Engine Serial No.
Engine Displacement (cu in) Maximum rated output (bhp) Typical load as % of bhp rating
Is this an emergency/standby engine? Yes No
Is this emergency generator being installed in response to PG&E’s PSPS program?* Yes No
*The Air District is collecting information on emergency generators that are being installed in response to PG&E’s Public Safety Power Shutoff (PSPS)
program. If you are completing this form for an emergency generator, please mark “Yes” if you are installing this emergency generator because of the
PG&E PSPS program. Note: Marking “Yes” will NOT limit the operation of the emergency generator to only PSPS power outages
.
----------------------------------------
(Check all that apply below)
Certification: EPA Certified CARB Certified CARB Executive Order No.
None (If None is checked, please indicate below the items applicable to this engine.)
Naturally aspirated Supercharged Turbocharged Inter-cooled After-cooled
Timing retard ≥ 4º
Lean-burn Rich-burn
Primary Use: Electrical generation Cogeneration Pump driver Fire pump driver
Compressor driver Tub grinder driver Other:
Abatement device number A (If “New” leave blank) New Existing
Device type: Diesel catalyzed particulate filter Oxidation catalyst Selective catalytic reduction (SCR)
Non-selective catalytic reduction (NSCR or 3-way catalyst) Other:
Make, Model, and Rated Capacity
Abatement device control efficiencies at typical operation (Use the basis codes listed below. If unknown leave blank)
Control Efficiency/Emission Factor Basis Codes: (Submit supporting documentation if available)
1. SUMMARY New Construction Modification Loss of Exemption
(1)
Source testing or other measurement by plant
(8) Guess
(2) Source testing or measurement by BAAQMD (BAAQMD only) (9) EPA/CARB Certification
(3) Specification from vendor
(4) Material balance by plant using knowledge of process
(5) Material balance by BAAQMD (District use only)
(6) EPA Document AP-42 Emission Factors
(7)
Taken from literature other than AP-42
2. ENGINE INFORMATION Check here if applying for a multiple location permit. (See Reg. 2-1-413 for requirements)
3. ABATEMENT DEVICE INFORMATION Complete this section only if the engine has an add-on abatement device.
Check here if the engine has more than one add-on abatement device and complete a separate Form A for each additional abatement device.
Form ICE Rev 09/18/19 Page 2 of 2
BAY AREA AIR QUALITY MANAGEMENT DISTRICT Form ICE
Internal Combustion Engines
Emission point number P (If “New” leave blank) New Existing
Stack outlet height from ground level (ft)
Diameter of stack outlet (inches) or Outlet cross-section area (square inches)
Direction of outlet (check one) Horizontal Vertical End of outlet (check one) Open/hinged flap Rain cap
Exhaust rate at typical operation (acfm) Exhaust temperature at typical operation (ºF)
5. RISK ASSESSMENT INFORMATION
Distance from engine to the property line of the nearest residence (ft) or (check if) Greater than one mile
Distance from engine to the property line of the nearest school
1
(ft) or (check if) Greater than 1000 ft
1
K-12 and more than twelve children only.
Describe the nearest non-residential, non-school site (check one) Industrial Commercial Hospital
Day care center Other
Distance from engine to the property line of the nearest non-residential, non- school site(ft) or Greater than one mile
6. FUEL DATA Complete the table below for each fuel burned. If you are using a fuel other than those listed in the fuel code table,
attach a fuel analysis indicating the higher heating value, sulfur content, and nitrogen content. Please clearly indicate the
measurement unit that corresponds to the information you are submitting. Check here if you are using more than two fuels, and
attach a copy of this page listing the additional fuels.
Fuel Code
1
Primary
Name
Fuel
Fuel Code
1
Secondary
Name
Fuel
Maximum Fuel Use Rate
2
gal/hr or SCF/hr
Maximum Fuel Use Rate
2
gal/hr or SCF/hr
Annual Fuel Usage
3
gal/yr or therm/yr
or SCF/yr
Annual Fuel
Usage
3
gal/yr or therm/yr
or SCF/yr
Typical Heat Content
4
BTU/gal or BTU/SCF
Typical Heat Content
4
B
TU/
gal or
BT
U/SCF
Sulfur Content
4
wt% liquids or ppmv gases
Sulfur Content
4
wt% liquids or ppmv gases
Emission Factors (Optional)
Emission Factors (Optional)
Pollutant Name Emission
Factor
Units
5
Basis
Code
6
Abated
Factor
( √ )
7
Pollutant Name Emission
Factor
Units
5
Basis
Code
6
Abated
Factor
( √ )
7
Particulates
Particulates
Organics
Organics
Nitrogen Oxides
Nitrogen Oxides
Carbon Monoxide
Carbon Monoxide
Others – Check here and attach a separate list under each fuel used. Others – Check here and attach a separate list under each fuel used.
1. Fuel Codes: Diesel (98) Bio Diesel B100 (815) Bio Diesel B20 Blend (816) Gasoline (551)
Natural Gas (189) Landfill Gas (511) Digester Gas (493) Liquid Petroleum Gas (LPG) (160)
2. Maximum fuel use rate units: gallon/hr for liquid fuels and SCF/hr for gaseous fuels. (SCF =Standard Cubic Foot)
3. The annual fuel usage is the actual or projected engine fuel consumption over a rolling 12-month time period. Annual usage units: gallons for
liquid fuel, therms for natural gas, and SCF for other gaseous fuels. (therm = 100,000 BTUs, BTU =British Thermal Unit)
4. If you are using diesel, natural gas, or gasoline, you may skip this entry. Heat content units: BTU/gallon for liquid fuels, BTU/SCF for gaseous
fuels. Sulfur content units: weight % for liquid fuels, ppmv for gaseous fuels. (ppmv = parts per million by volume)
5. Emission factors may be reported as gram/brakehp-hr, or as lb per gallon, or as lb per therm, or as lb per SCF.
6. See the Control Efficiency/Emission Factor Basis Code table under Section 3 on page 1 of this form.
7. Place a check in this column if the emission factor applies to emissions after abatement by an add-on abatement device.
7. CERTIFICATION I hereby certify that all information contained herein is true and correct. (Please sign and date this form)
Name of person certifying (print) Title of person certifying Signature of person certifying Date
4. EMISSION POINT/STACK INFORMATION Check here if the engine has more than one stack or has a continuous pollutant
emission monitor and complete one Form P for each emission point.
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Completed 19 July 2020

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