Fillable Form used to calculate emissions and to be (SCAQMD)

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Form used to calculate emissions and to be (SCAQMD)

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Tel: (909) 396-3119
www.aqmd.gov
Mail To:
SCAQMD, RECLAIM Administration
P.O. Box 4830
Diamond Bar, CA 91765-0830
South Coast Air Quality Management District, Form NOx/SOx-5 (2014.07)
Page of
South Coast Air Quality Management District
Form NOx/SOx-5
Regional Clean Air Incentives Market (RECLAIM)
Recordkeeping Form for Non-Fuel Based Sources And Units
Form used to calculate emissions and to be kept at the Facility.
Facility Name: Facility I.D. #:
Select One:
Monthly: Month: Year: Pollutant: NOx or SOx
Quarterly: Quarter Begins:
Quarter Ends: Pollutant: NOx or SOx
(If known)
Reported By
Title Phone # Ext. Date
(Signature) (Print or Type Name)
(Print or Type Title)
(A) (B) (C) (D) (E) (F)
Measuring
Instrument
(I.D. #)
Device
(I.D. #)
Final
Reading
(a)
Initial
Reading
(b)
Process
Total
(c) = (a-b)
Appropriate
Units
Associated
Emission
Factor
Equipment-Specific
Monthly Emissions
(LBS)
(c)x(F)
Recorded Data
Process (Monthly or Quarterly)
(Identify one pollutant only)
 Use This Form only if emissions cannot be calculated on forms NOx/SOx-2, NOx/SOx-3 or NOx/SOx-4
 Use Form NOx/SOx-1 and Quarterly Certification of Emissions to report emissions to the AQMD
(Identify one pollutant only)
C
C
C
C
C
C
C
C
C
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Form used to calculate emissions and to be (SCAQMD)

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Completed 12 August 2020

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