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AIR POLLUTION CONTROL PERMIT APPLICATION FORM 4500-1S: STACK IDENTIFICATION One form should be completed for each stack or release point (e.g., roof vent, wall vent, etc.) from which the air pollution source(s) to be permitted will vent its emissions. Item 1 — Provide the facility name. Item 2 — Assign an identification number for this stack or release point (e.g., S-1, S-2, etc.). This number should also appear on the appropriate Form 4500-1B, 1C, 1D, 1I, 1P, and IT completed for the air pollution source(s) and control device(s) which will vent through this stack or release point. Item 3 — Provide an identification for the source(s) which will vent its emissions through this stack or release point. This number should also appear on the appropriate Form 4500-1B, 1C, 1D, 1I, 1P, and IT completed for this source(s). Item 4 — Provide the height at which the stack or release point discharges above ground level in units or feet. Item 5 — Check appropriate shape of the stack or release point. For circular shapes provide the diameter in units of feet, and for rectangular shapes provide the length (L) and width (W) in units of feet. Item 6 — Provide the normal exhaust flow rate in units of actual cubic feet per minute (ACFM) and the maximum exhaust flow rate expected in ACFM. Item 7 — Provide the normal and maximum exhaust gas temperatures in °F. Item 8 — Self explanatory. Item 9 — Check appropriate discharge direction. If the direction of discharge is at an angle, check the nearest direction. Item 10 — Identify this stack or emission release point on the plot plan required for Item 7 of Form 4500-1A: Facility and Project Identification. Item 11 — For stacks constructed of more than one material, attach a cross-sectional diagram of the stack identifying these materials and their thicknesses. Item 12 — Self explanatory. Item 13 — Self explanatory. Item 14 — If the stack is equipped with continuous monitoring equipment identify the pollutant monitored such as TRS (Total Reduced Sulfur), NOx, SO2, 02, CO2, or Opacity. For each pollutant monitored, provide the equipment manufacturer and model number and a diagram indicating its location on the stack. Item 15 — Complete the table with air pollution emissions data for the sources to be permitted if data is available. If data is not available, or estimates cannot be made, a stack test may be required of this source to quantify the emissions. A. For each column identify each source exhausting its emissions through this stack. Use the appropriate source identification number (e.g., B-1, C-1, P-1, etc.). B. Check the units used for each pollutant, either pounds per hour (lbs./hr.) or actual parts per million (ppm). If ppm are used, indicate if the units are on a weight or volume basis. C. Provide the emission rate of particulates, sulfur dioxide, nitrogen oxides, carbon monoxide, hydrocarbons, and/or lead from each source exhausting through this stack. Provide the emission rate of any hazardous pollutant emitted in significant quantities. D. If more than one source will exhaust through this stack, provide the percentage (%) of total stack gas flow contributed by each source under normal operation. E. Self explanatory. Item 16 — Complete the appropriate Form 4500-1B, 1C, 1D, II, 1P, and IT for each source which exhausts its emissions through this stack.