Air Quality Permit Modification – Environmental Health and Safety

Requested by *

Email Address *

Building *

Phone Number *

Fax Number

Project or Work Order Number *

Start Date *

Completion Date *

Billing Contact

Billing Contact Address

BU

OrgID

Fund

Activity or Project

Account

Equipment Type

(natural gas-fired generator, diesel-fired generator, dual-fuel boiler, natural gas boiler, etc.)

Equipment Size

(heat input in BTU/hr for boilers / HP or KW for generators)

Projected Equipment Use

Schedule and operating conditions (e.g.: hot standby for boilers, no-load for generators, emergency backup; 3 hours per day 5 days per week; etc.)

Include manufacturer guarantees and units (e.g. grams/hp-hr)

NOx

SOx

PM10

CO

VOCs

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