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-4 (2014.07)
Page of
South Coast Air Quality Management District
Form NOx/SOx-4
Regional Clean Air Incentives Market (RECLAIM)
Recordkeeping Form for Process Units or Rule 219 Exempt Units With Timers*
Form used to calculate emissions and to be kept at the Facility. Use NOx/SOx-1 (third & final month) and Quarterly Certification of Emissions to report emissions to the AQMD.
Facility Name: Facility I.D. #:
Quarter Begins:
Quarter Ends: Pollutant: NOx or SOx Associated Fuel Meter I.D. #
(If known)
Reported By
Title Phone # Ext. Date
(Signature) (Print or Type Name)
(Print or Type Title)
Recorded Data Reported Data
(o) (k) (l) (m) (n) (p) (r) (s) (u)
Timer
(I.D. #)
Device*
(I.D. #)
Device
Type
Final
Reading
Initial
Reading
Operating
Hours
(HRS/QTR)
(k)-(l)
Rated
Capacity
Maximum Heat
Input
(MMBTU/QTR)
(m)x(n)
Estimated
Quarterly
Fuel Usage
(b)x(p)/(q)
Emission
Factor
Quarterly
Emissions
(LBS/QTR)
(r)x(s)
(q) Total Maximum Heat Input:
(Identify one pollutant only)
(a) 1 - Natural Gas only 4 - Natural Gas - Residual Oil 7 - Process Gas - (includes Refinery Gas) 10 - Methanol 13 - Other Fuel
2 - Oil only 5 - Gasoline 8 - Wood 11 - Natural Gas - Methanol
3 - Natural Gas - Distillate Oil 6 - Natural Gas - LPG 9 - Coal 12 - Diesel
(b) Units in LBS/QTR refer to solid fuels only.
(c) Units in MMBTU/LB refer to solid fuels only. If necessary, heating value is used to convert the associated emission factors to appropriate units of fuel usage.
(o) “P” for Process Units, “E” for Rule 219 exempt units, and “S” for fuel meter sharing of the above mentioned equipment.
* Device I.D. # is not required for equipment exempt under Rule 219.
(a) Fuel Type
(b) Total Quarterly Fuel Usage
(MMSCF, MGAL, or LBS/QTR)
(c) Heating Value of Fuel Usage
(MMBTU/MMSCF, MMBTU/GAL or MMBTU/LB)
