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Form Ice Word (Bay Area Air Quality Management District)

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BAY AREA AIR QUALITY MANAGEMENT DISTRICT
Form ICE
375 Beale Street, Suite 600, San Francisco, CA 94105
Internal Combustion Engines
Engineering Division
(415) 749-4990
www.baaqmd.gov
fax
(415) 749-5030
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, you must also complete Form HRSA Health Risk Screen
Analysis. Additional forms and all District regulations and rules are available on the District’s web site. Contact your assigned permit
engineer or the Engineering Division at the above telephone number if you need assistance completing this form. Please include the
engine manufacturer’s equipment specifications.
1. SUMMARY
New Construction
Modification
Loss of Exemption
Company Name
Plant No.*
Source Description
Source No.*
Initial Date of Operation
(Not required for modification of an existing permitted source)
*(If unknown leave blank)
Operating Schedule
Typical hrs/day
Days/week
Weeks/yr
Maximum hrs/day
2. ENGINE INFORMATION
Check here if applying for a portable equipment permit. (See Reg. 2-1-413 for requirements)
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
(Complete and check all that apply)
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:
3. ABATEMENT DEVICE INFORMATION Complete this section only if the engine exhausts to 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.
Abatement device number
A
(If unknown 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)
Pollutant Name
Wt %
Reduction
Basis
Code
(1) Source testing or other measurement by plant (8) Guess
Particulates
(2) Source testing or measurement by BAAQMD (District use only) (9) EPA/CARB Certification
Organics
(3) Specification from vendor
Nitrogen Oxides
(4) Material balance by plant using knowledge of process
Sulfur Dioxide
(5) Material balance by BAAQMD (District use only)
Carbon Monoxide
(6) EPA Document AP-42 Emission Factors
Others – Check here and attach a
separate list of pollutants. Include the basis
code and the control efficiency.
(7) Taken from literature other than AP-42
Continued on reverse side
Form ICE Rev 04/12/16 Page 1 of 2
BAY AREA AIR QUALITY MANAGEMENT DISTRICT
Form ICE
Internal Combustion Engines
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..
Emission point number
P
(If unknown 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
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
1. K-12 and more than twelve children only.
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.
Primary Fuel
Fuel Code
1
Name
Maximum Fuel Use Rate
2
gal/hr or SCF/hr
Annual Fuel Usage
3
gal/yr or therm/yr or SCF/yr
Typical Heat Content
4
BTU/gal or BTU/SCF
Sulfur Content
4
wt% liquids or ppmv gases
Emission Factors (Optional)
Pollutant Name
Emission
Factor
Units
5
Basis
Code
6
Abated
Factor
( )
7
Particulates
Organics
Nitrogen Oxides
Carbon Monoxide
Others – Check here and attach a separate list under each fuel used.
Secondary Fuel
Fuel Code
1
Name
Maximum Fuel Use Rate
2
gal/hr or SCF/hr
Annual Fuel Usage
3
gal/yr or therm/yr or SCF/yr
Typical Heat Content
4
BTU/gal or BTU/SCF
Sulfur Content
4
wt% liquids or ppmv gases
Emission Factors (Optional)
Pollutant Name
Emission
Factor
Units
5
Basis
Code
6
Abated
Factor
( )
7
Particulates
Organics
Nitrogen Oxides
Carbon Monoxide
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
Approved By: ________________________ Date: _______________ Entered By:_______________________ Date: _____________
(District Use Only) Form ICE Rev 04/12/16 Page 2 of 2
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Completed 19 July 2020

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