(PART 1 & 2 – Tax Payer & Representative Identification)
Self Explanatory
(PART 3 – Plant & Property Location)
Describe the location and nature of the operating property where the pollution control equipment is
operated. Include physical address and/or legal description of the property, county, and tax district,
date placed into service.
(PART 4 – Exemption Request)
Detailed description of the individual facility, device, equipment, etc. being considered for
exemption (wet scrubber, electrostatic precipitators, etc.). One item per application, do not combine
multiple pieces of equipment on an application. Include Make, Model, and/or Serial Number (or
any other identifiers), date placed into operations, and pollutant contained.
Cite the government agency & specific citation of law mandating pollution control.
Citation Example: Wyoming Environmental Quality Act – 35-11-301 (a)(i); WDEQ Application 06-
852 in accordance with Chapter 3, Section 9 of the Wyoming Water Quality Rules & Regulations.
Any applications failing to provide this information will be denied in their entirety.
(PART 5 – Installed Cost)
Self Explanatory
(PART 6 – Emissions / Marketable By-Product)
(Line Items 32 & 33) If applicable. List the contaminants which evolve from the unit
process and which are discharged into the air, water or land. The rates of emissions with and
without the facility should be expressed in pounds per hour and tons per year and the efficiency of
control shown on the basis of design and actual performance test.
(Line Item 34) If pollutants are considered wasted, describe the method of disposal and retention of
material. If collected material is recycled within the operation, indicate the portion, which is
considered recoverable as a marketable product.
If such material is recovered directly as marketable by-product, indicate the portion of such
material, which is thus disposed. Describe the pollutants recovered and marketable. Provide an
explanation of the marketing process and the revenue agreements and how the revenue is handled in
the accounting process.
(PART 7 – Construction Work In Progress)
Provide any supplemental detail, including cost information for pollution control including within
Construction Work In Progress accounts.
