Department of Environmental Quality Office of Environmental Services Air Permits Division P.O. Box 4313 Baton Rou e!

"A #$%&1'4313 (&&)* &1+'31%1

Instructions Regulatory Permit Notification Form Flaring of Materials Other than Natural Gas
"DEQ 3etermines t-at t-e 0otification .orm is complete. At t-at time! "DEQ recor3s 5ill s-o5 t-at t-e Re ulatory Permit -as expire3. (ine)by)(ine Instructions * Facility Information Facility or Pipeline B Enter t-e name of t-e facility or pipeline at 5-ic- t-e flarin event 5ill occur. Owner B Enter t-e name of t-e company t-at o5ns t-e affecte3 facility or pipeline. Operator B Enter t-e name of t-e company t-at operates t-e affecte3 facility or pipeline if t-is company is a 3ifferent entity t-an O5ner and 5ill 4e responsi4le for environmental compliance. Agency Interest (AI) Number B 8f t-e flarin event 5ill occur at an existin facility for 5-ic- an air permit -as 4een o4taine3! enter t-e A8 num4er for t-at facility. Ot-er5ise! enter C,BD.D Permit Number (If Applicable) B 8f t-e flarin event 5ill occur at an existin facility for 5-ic- an air permit -as 4een o4taine3! enter t-e permit num4er for t-at facility. Ot-er5ise! enter C0one.D + Physical (ocation Nearest Town and Parish B Enter t-e nearest to5n an3 t-e paris- in 5-ic- t-e flarin event 5ill occur. ,-e to5n must 4e in t-e paris- i3entifie3! even if anot-er to5n in a nei -4orin paris- is p-ysically closer. Latitude and Longitude B Enter t-e latitu3e an3 lon itu3e of t-e affecte3 facility or location of t-e flarin event. Physical Address or ri!ing irections B 8f a p-ysical C+11D a33ress of t-e location -as 4een esta4lis-e3! enter t-at a33ress -ere. 8f not! provi3e 3rivin 3irections. "ap Attached B Attac- a map of t-e location at 5-ic- t-e flarin event 5ill occur. ,-e map s-oul3 s-o5 t-e names of t-e surroun3in -i -5ays an3 4e 3etaile3 enou - suc- t-at "DEQ staff can pinpoint t-e location of t-e flarin event. 8nstructions for Re ulatory Permit 0otification .orm .larin of /aterials Ot-er t-an 0atural 1as Pa e 1

Introduction ,-e .larin of /aterials Ot-er t-an 0atural 1as Re ulatory Permit aut-ori2es t-e flarin of aseous materials ot-er t-an natural as (e. .! propane! et-ylene! propylene! ammonia* resultin from meterin ! pur in ! an3 maintenance operations. ,-e material to 4e flare3 may 4e supplemente3 5itnatural as. Approval to procee3 is contin ent upon notification 4y "DEQ t-at t-e application (i.e.! 0otification .orm* -as 4een 3etermine3 complete. ,-is Re ulatory Permit is co3ifie3 un3er "A6 337888.31+. 6opies of t-is re ulation are availa4le at7 -ttp799555.3e:.louisiana. ov9portal9Default.aspx; ta4i3<1=#4. Do not alter t-e formattin of t-e Re ulatory Permit 0otification .orm in any 5ay! except as specifie3 in t-ese 8nstructions. Where Should I Submit the Notification Form? ,-e 0otification .orm s-oul3 4e maile3 to t-e Assistant Secretary of t-e Office of Environmental Services at t-e a33ress provi3e3 on pa e 3 of t-e 0otification .orm suc- t-at "DEQ receives t-e form at least t-ree (3* 5or>in 3ays prior to t-e flarin event. 8n emer ency situations! "DEQ 5ill 5aive t-e 3'5or>in 3ay re:uirement. 8f an applicant c-ooses to use a service provi3er ot-er t-an t-e ?.S. Post Office! "DEQ@s p-ysical a33ress is7 =$& 0ort- .ift- Street Baton Rou e! "ouisiana #$%$& What Should Be Submitted and What Should be e!t ,ransmit t-e certifie3 0otification .orm an3 attac-ments an3 one p-otocopy to "DEQ as 3escri4e3 a4ove. Aeep a copy of t-e form an3 attac-ments for your recor3s. Once the Flaring "#ent $as Been %om!leted& What 'o I Need to 'o? Once t-e flarin event is complete! t-ere is no nee3 to rescin3 t-e Re ulatory Permit. ,-e aut-ori2ation conveye3 4y t-e .larin of /aterials Ot-er t-an 0atural 1as Re ulatory Permit 5ill remain effective for sixty (=$* 3ays follo5in t-e 3ate on 5-icformE#3)&Er$$ $)91#913

Department of Environmental Quality Office of Environmental Services Air Permits Division P.O. Box 4313 Baton Rou e! "A #$%&1'4313 (&&)* &1+'31%1

Instructions Regulatory Permit Notification Form Flaring of Materials Other than Natural Gas
con3itions (&1H6 or #$H. an3 &+.+& inc-es (#=$ millimeters* of mercury*. 8n3icate if t-e material to 4e flare3 5ill 4e supplemente3 5it- natural as. 34 Reason for the Flaring "#ent Descri4e t-e circumstances resultin in t-e nee3 to flare t-e aseous material. 5 "6ui!ment In#ol#ed "ist t-e emissions sources associate3 5it- t-e flarin event. Emissions sources may inclu3e! 4ut are not limite3 to! a flare an3 fu itive emissions. Enter t-e maximum operatin rate for eac- source. 7 "missions 8n3icate if emissions calculations are attac-e3. ,-is 4ox serves as a remin3er t-at calculations are re:uire3 in all instances. "DEQ 5ill not process any 0otification .orm t-at fails to inclu3e calculations. Enter emissions of criteria pollutants! reen-ouse ases (1I1s* (i.e.! car4on 3ioxi3e e:uivalents*! an3 "A6 337888.6-apter )1're ulate3 toxic air pollutants (,AP* t-at 5ill result from t-e flarin event (in tons to t5o 3ecimal places*. 1I1s may 4e reporte3 to t-e nearest ton. A33 a33itional ro5s as necessary for ,APs. *8 (9% ,,:I4*38* Re6uirements 8n accor3ance 5it- "A6 337888.)$1.6.1$! 4efore issuin any (initial* permit for a ne5 or existin source! "DEQ may con3uct an evaluation of t-e applicant as 3escri4e3 in "A6 3378.1#$1. Ans5er t-e :uestions as appropriate! an3 attac- t-e o5ner or operator@s 6ertificate of Re istration an39or 6ertificate of 1oo3 Stan3in if necessary. ,-ese certificates can 4e o4taine3 from t-e Secretary of State. See -ttp799555.sos.la. ov9Iome96ommercial96orporatio ns9Searc-Data4ase9ta4i39%1+9Default.aspx. **4 %ertification by Res!onsible Official Enter t-e contact information re:ueste3. All 5ritten correspon3ence concernin t-e 0otification .orm 5ill 4e 3irecte3 to t-e Responsi4le Official. A responsi4le official must si n an3 3ate t-e 0otification .orm. ,-e 0otification .orm cannot 4e 8nstructions for Re ulatory Permit 0otification .orm .larin of /aterials Ot-er t-an 0atural 1as Pa e &

, %ontact Information Enter t-e contact information re:ueste3. ,-e person liste3 -ere 5ill 4e t-e primary contact of "DEQ s-oul3 :uestions arise. ,-is contact nee3 not 4e t-e Responsi4le Official i3entifie3 in Section 11! 4ut s-oul3 4e an employee of t-e O5ner9Operator! not t-e O5ner9Operator@s consultant. 0ote t-at t-e contact@s cell p-one num4er an3 e'mail a33ress are optional. 0ote t-at all 5ritten correspon3ence concernin t-e 0otification .orm 5ill 4e 3irecte3 to t-e Responsi4le Official. - Fee Information Enter t-e fee information re:ueste3. Per "A6 337888.31+.8 an3 in accor3ance 5it- "A6 337888.6-apter &! t-e fee for t-e .larin of /aterials Ot-er t-an 0atural 1as Re ulatory Permit s-all 4e F3$$.$$ (fee num4er 1#1$*. 6-ec>s or money or3ers s-oul3 4e paya4le to t-e C"ouisiana Department of Environmental Quality.D Do not sen3 cas-. "DEQ cannot process t-e 0otification .orm until t-is fee is pai3 in full. 0ote t-at t-ere is no annual maintenance fee associate3 5it- t-is Re ulatory Permit. . 'ate/s0 and "1!ected 'uration of Flaring "#ent Enter t-e 3ate on 5-ic- t-e flarin event is sc-e3ule3 to commence. ,-e aut-ori2ation conveye3 4y t-e .larin of /aterials Ot-er t-an 0atural 1as Re ulatory Permit s-all remain effective for sixty (=$* 3ays follo5in t-e 3ate on 5-ic- "DEQ 3etermines t-at t-e 0otification .orm is complete! so if t-e flarin event 3oes not commence on t-e 3ate specifie3! t-ere is no nee3 to mo3ify t-e 0otification .orm. Enter t-e expecte3 3uration of t-e flarin event. Duration of t-e flarin event must 4e no more t-an 1$ calen3ar 3ays! else t-e event 3oes not :ualify for covera e un3er t-is Re ulatory Permit per "A6 337888.31+.E. 2 Identification of the Material to Be Flared 83entify t-e aseous material to 4e flare3 an3 its approximate -i -er -eatin value (in Btu per stan3ar3 cu4ic foot*. Enter t-e volume of aseous material to 4e flare3 (in stan3ar3 cu4ic feet*. Golumes of as s-oul3 4e calculate3 at stan3ar3 formE#3)&Er$$ $)91#913

Department of Environmental Quality Office of Environmental Services Air Permits Division P.O. Box 4313 Baton Rou e! "A #$%&1'4313 (&&)* &1+'31%1

Instructions Regulatory Permit Notification Form Flaring of Materials Other than Natural Gas

processe3 if t-e certification statement is not si ne3 or is si ne3 4y someone ot-er t-an a responsi4le official. ,-e 3efinition of Cresponsi4le officialD as set fort- in "A6 337888.)$& is as follo5s7 #esponsible Official$one of t-e follo5in 7 1. for a corporation7 a presi3ent! secretary! treasurer! or vice'presi3ent of t-e corporation in c-ar e of a principal 4usiness function! or any ot-er person 5-o performs similar policy or 3ecision'ma>in functions for t-e corporation! or a 3uly aut-ori2e3 representative of suc- person if t-e representative is responsi4le for t-e overall operation of one or more manufacturin ! pro3uction! or operatin facilities applyin for or su4Ject to a permit an3 eit-er7 a. t-e facilities employ more t-an &)$ persons or -ave ross annual sales or expen3itures excee3in F&) million (in secon3 :uarter 1+%$ 3ollars*K or 4. t-e 3ele ation of aut-ority to sucrepresentatives is approve3 4y t-e permittin aut-ority prior to su4mittal of any certification 4y suc- personK &. for a partners-ip or sole proprietors-ip7 a eneral partner or t-e proprietor! respectively. 8f a eneral partner is a corporation! t-e provisions of Su4para rap- a of t-is 3efinition applyK 3. for a municipality! state! fe3eral! or ot-er pu4lic a ency7 eit-er a principal executive officer or ran>in electe3 official. .or t-e purposes of t-is 3efinition! a principal executive officer of a fe3eral a ency inclu3es t-e c-ief executive officer -avin a responsi4ility for t-e overall operations of a principal eo rap-ic unit of t-e a ency.

formE#3)&Er$$ $)91#913

8nstructions for Re ulatory Permit 0otification .orm .larin of /aterials Ot-er t-an 0atural 1as Pa e 3