Fillable P-101c-pdf Title V - SMOP

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P-101c-pdf Title V - SMOP

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Engineering Division
Bay Area Air Quality Management District
375 Beale Street, Ste# 600, San Francisco, CA 94105
415-749-4990
Form P-101C
Application # : _
(For District Use)
BUSINESS NAME:
PLANT #:
APPLICATION FOR SYNTHETIC MINOR OPERATING PERMIT
This application form is to be used for all initial applications for synthetic minor operating permits, as well as for applications
to modify synthetic minor operating permits. It is to be used in lieu of District P-101B. Note: if a proposed modification would
increase emissions above any threshold for a major facility, then the plant must apply for an authority to construct using form
P-101B and must apply for an MFR permit in accordance with Regulation 2, Rule 6, Major Facility Review.
Other Business Name
Parent Company
(if any)
Mailing
Address
Street Address or PO Box
City
State
Zip Code
Phone Number
( - )
Fax Number
( - )
Plant
Address
Street Address or PO Box
City
State
Zip Code
Phone Number
-( )
Fax Number
-( )
Plant Contact
Title
Plant Contact's Company (if different from above)
Relation to Project
Responsible Official
Title
Principal Product/Operation
Number of Permitted Sources
Status (mark all that apply)
Initial Application for Synthetic Minor Permit
Emission Factor Revised (Attach Data Form X)
Application for New or Modified Source(s)
Establishes New Federally Enforceable Conditions
Revisions to Existing Federally Enforceable Conditions
Banking
Revisions to Existing Non Fed. Enforceable Conditions
Existing Unpermitted Source(s)*
*Date Installed j
In order to expedite your application the following items must be enclosed:
Form SMOP-ES (Emissions Summary)
Proposed Permit Conditions
Form SMOP-EX (Exempt Sources)
Proposed Record-keeping Requirements
Emission Calculations
Source Offsets (if applicable
In addition to the above, applications for new and modified sources must include the following:
Project Description and Flow Diagram
BAAQMD Data Forms
Mfr.'s Equipment Description & Data
F:\Title V Forms 2010\p-101c.doc 5/3/2016
-OVER-
IMPORTANT:
Under the California Public Records Act, all information in your permit application will be
considered a matter of public record and may be disclosed to a third party. If you wish to
keep certain items separate as specified in Regulation 2, Rule 1, Section 402.7, please
complete the following steps:
(a) Make a copy of your permit application with the confidential information blanked
out. Label this copy "Public Copy".
(b) Label the original copy "Confidential." Circle all confidential items on each page.
Label each page with confidential information "Confidential".
(c) Prepare a written justification for the confidentiality of each confidential item.
Append this to the confidential copy.
ACKNOWLEDGEMENT (Please initial) _ _____
NOTICE To avoid delay of processing, mail completed application to:
Engineering Division
Bay Area Air Quality Management District
375 Beale Street, Suite 600, San Francisco, CA 94105
(Do not mail to an individual)
Note: EPA and other agencies may request a copy of your complete application. For further information, you
should contact the local city or county office of permit assistance within the Office of Planning and Research in
Sacramento.
Office of Planning and Research
1400 Tenth Street
Sacramento, CA 95814
(916) 332-4245
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Completed 19 April 2020

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