522637010.

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PERMIT APPLICATION FOR AUTHORIZATION TO CARRY OUT

LOADING/ UNLOADING OPERATIONS

1. DESCRIPTION OF LOADING / UNLOADING OPERATIONS

a. Is there loading/ unloading of fluids that may contain Volatile Organic Compounds
(VOC) or Organic Hazardous Air Pollutants (HAP) at the facility

[ ] Yes [ ] No

b. Is there loading/ unloading of fluids that may contain Volatile Organic Compounds
(VOC) or Organic Hazardous Air Pollutants (HAP) at the port

[ ] Yes [ ] No

c. Is there loading/ unloading of bulk materials that may emit dust or suspended
particulate matter at the facility

[ ] Yes [ ] No

d. Is there loading/ unloading of bulk materials that may emit dust or suspended
particulate matter at the port

[ ] Yes [ ] No

If the answer to any of the above questions is yes, please provide details on the
loading/ unloading operations.

List the relevant section/ page numbers in the attachment

e. Provide a site plan indicating the locations of loading / unloading assemblies

Drawing No. _________________

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Facility: ______ Initials: ______
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DETAILS ON MATERIALS TO BE LOADED/ UNLOADED: (add additional rows if

necessary)

Maximum Average Temperature True vapor

Material Quantity Quantity Frequency Molecular of fluid pressure of
loaded/ loaded/ Weight loaded/ fluid at
unloaded unloaded unloaded temp. of
(t/d) (t/y) (oC) loading
(psi)

2. DETAILS ON THE METHOD OF LOADING/ UNLOADED

a.Type of Cargo [ ] Road Tanker [ ] Ship

[ ] ISO Container
[ ] Other (specify): ___________

b. Method of Loading/ Unloading [ ] Submerged [ ] Vapor balance

[ ] Splash
[ ] Other (specify): ___________

c.Tanks Loaded/ Unloaded [ ] Dedicated [ ] Multiple use

[ ] Ship
[ ] Other (specify): ___________

3. EMISSIONS CONTROL

Are there any emission control systems in place?

[ ] Yes [ ] No

If yes, please specify type of the control device

Source Control Control Pollutant Pollutant Pollutant Control

Device Unit ID Inlet Conc. Inlet Load Efficiency
(mg/m 3) (t/y) (%)

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Provide technical information, design details along with vendor guarantees for each
control device

List the relevant section/ page numbers in the attachment

4. AIR POLLUTANTS

Complete the following table for all emission sources. For sources that are equipped
with an emission control device, provide data after the emission control.

Source Unit Pollutant Max Max. Conc. Max. Avg. Emission

ID Conc. in Regulated Unit Emission Emission Estimation
(mg/m3) Rate Rate Technique*
Conc. Unit (kg/hr) (t/yr)

* Emission estimation must be based on one of the following

EF: Emission Factors
MB: Material Balance
ST: Stack testing or monitoring
EC: Engineering Calculation

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5. EMERGENCY RESPONSE PLANNING

a. Does the emergency response plan cover accidents or spills that might take place
from the loading and unloading operations

[ ] Yes [ ] No

If yes, please provide a summary of the plan

List the relevant section/ page numbers in the attachment

If no, please provide a date when the plan will be ready: ___________

b. Describe the measures employed for prevention of material spills.( Include information on
spill trays, nature of loading arms, slop tanks, spill kits. Pump compressor seals etc.)

6. ADDITIONAL INFORMATION FOR USEPA AP-42 CALCULATIONS

Please provide the following information for each material loaded/unloaded which is used
for AP 42 Calculations (insert more columns if necessary)

Source
Name of material loaded
Type of cargo
(Trucks/Ships/Barges)
Type of loading
(Fill as per note-1 below)
Number of loading arms (if applicable)
Molecular weight of vapor at 60oF
(lb/lb-mole)
Temperature of liquid loaded,
Deg F
Vapor pressure of liquid at the above temperature,
psia
Average loading rate for each arm, ton/hr
Note-1: Type of loading:
A - Submerged loading of a clean cargo tank
B - Submerged loading with dedicated normal service
C - Submerged loading with dedicated vapor balance service
D - Splash loading of a clean cargo tank
E - Splash loading with dedicated normal service
F - Splash loading with dedicated vapor balance service
G - Submerged loading into ship
H - Submerged loading into barge

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Facility: ______ Initials: ______