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1. Name of firm or organization:

2. Briefly describe the operation of this unit or process in your facility:(separate forms are to be submitted for each type of process or for multiple units of one process type.If the unit or process receives input material from, or provides input material to, another operation,please indicate the relationship between the operations.) Include a description of any operational limitations or work practices which limit emissions.

3. Type of unit or process (e.g. calcining kiln, cupola furnace):

Make:

Model:

Rated process capacity (manufacturer's or designer's guaranteed maximum) in pounds/hour

4. Normal operating schedule:

Hours Per Day:

Days Per Week:

Weeks Per Year:

Peak Production season (If any):

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05/02/2026Click to Sign

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Upload Attachment(s)

Please upload the following attachments:

If there is any emission control equipment on this emission unit or process, form APC107 must be completed and attached
If the unit or process is not in compliance with all applicable air pollution rules and regulations, a compliance schedule, form APC108, must be attached

There is a 250MB limit on each attachment.

Form APC 107 Click Here to Upload

Form APC 108 Click Here to Upload

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