DAQ-2024-010164

Utah Division of Air Quality Consulting Company: ____________________
New Source Review Section Address: ______________________________
______________________________
Form 16 Telephone Number: _____________________
Soil/Groundwater Fax Number:___________________________
Hydrocarbon Remediation Source Number: ________________________
Date: _________________________________

Contamination Information
1. Initial location of contamination (include address):
______________________________________________
______________________________________________
______________________________________________
______________________________________________
2. Amount of material contaminated (cubic yards or
tons of material being handled):
___________________________________________
___________________________________________
___________________________________________
3. Specific compounds contained in hydrocarbon contamination (list each by name, relative percentage of total and
volatility rate or vapor pressure:
Name _______________________________________________________________________
% of Total _______________________________________________________________________
Vapor Pressure _______________________________________________________________________
Maximum lb/ton or
Concentration ppm _______________________________________________________________________

Process Information
4. Remediation will be performed: □ On location □ In-situ □ Excavated
□ Excavated and transported to a new location
5. Type of unit/method used for remediation:
□ Soil vapor extraction □ Biodegradation □ In-situ leaching
□ Soil aeration (land farming) □ Asphalt Incorporation □ Groundwater stripping
□ Excavation □ Thermal Treatment □ Other _________________________
6. Attach flow diagram and site plan of process:
Soil Vapor Extraction

7. Fan/blower requirements:
_____________hp ______________ft3/min

8. Exhaust gas flow rate:
Design maximum: ___________acfm at ______oF
Average expected: ___________acfm at ______oF

9. Heater fuel: □ electric □ propane
□ kerosene □ other ________

10. Air flow control valves: □ Yes □ No
11. Stack height: ____________ Stack diameter: __________ Stack gas exit temperature: _______
12. Expected concentration flow
rate (grams/sec): _________
13. Pressure gauges: □ Yes
□ No
14. Flow meters: □ Yes
□ No
15. Attach discharge monitoring plan.

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Soil/Groundwater Hydrocarbon Remediation
Form 16 (Continued)

Biodegradation
16. Kind of nutrients added to soil: _________________
__________________________________________
17. Water flow rate:__________________acfm
18. Pump requirements: hp ________ft3\min________ 19. Number of wells: _____Recovery ____ Injection
In-situ Leaching
20. Surfactant used: ____________________________ 21. Pump requirements: hp ______ ft3\min ________
22. Leachate flow rate:
Design maximum: ______________acfm
Average expected: ______________acfm
23. Number of monitoring wells: _________________
________________________________________
24. Describe treatment of leachate: ________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

Thermal Treatment
25. Type of equipment: □ Rotary kiln □ Rotary drier □ Fluidized bed
□ Low-temperature thermal stripper □ Other _________________________________

26. Company performing the incineration: ____________
Approval Order # ____________________________
27. Incineration capacity (tons/hr, etc.):
______________________________________
Soil Aeration

28. Site of Aeration: _____________________________
_____________________________

29. Dimensions of aerated layer: _______ length
_______ width _______ depth

30. Type of soil: ________________________________
__________________________________________

31. Method to be used to turn the soil and frequency of
turning the soil: ____________________________
Asphalt Incorporation

32. Company using soil in asphalt: _________________

33. Approval Order # __________________________
Groundwater Stripping

34. Groundwater flow rate:
___________________gals/min

35. Type of treatment: □ Packet tower
□ Oil/water separator □ Carbon adsorption
□ Other_________________________________

36. Exhaust flow rate: ___________________________

37. Expected concentration flow rate (grams/sec):
______________________________

38. Stack height: ____________ Stack diameter: ____________ Stack gas exit temperature: ____________

39. Attach discharge monitoring plan

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Soil/Groundwater Hydrocarbon Remedation
Form 16 (Continued)

Excavation

40. Name of landfill being used: ___________________________________________________________________
Emission Controls

41. Type of control: □ Carbon Adsorption (Form 5) □ Afterburner (Form 3) □ Condenser (Form 7)
□ Baghouse (Form 10) □ Wet Scrubber (Form 9) □ Cover
□ Cyclone (Form 6) □ Other ______________________
42. Calculated emissions for this process:
PM10 ___________Lbs/hr___________ Tons/yr PM2.5___________Lbs/hr___________ Tons/yr
NOx ____________Lbs/hr___________ Tons/yr SOx ____________Lbs/hr___________ Tons/yr
CO ____________Lbs/hr___________ Tons/yr VOC ___________Lbs/hr___________ Tons/yr
CO2 ___________ Tons/yr CH4 ___________Tons/yr
N2O ___________Tons/yr
HAPs__________ Lb s/hr (speciate)__________Tons/yr (speciate)
Submit calculations as an appendix. If other pollutants are emitted, include the emissions in the appendix.

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Instructions Form 16 - Soil/Groundwater Hydrocarbon Remedation

NOTE: 1. Submit this form in conjunction with Form 1 and Form 2.
2. Call the Division of Air Quality (DAQ) at [phone] if you have problems or questions in filling
out this form. Ask to speak with a New Source Review engineer. We will be glad to help!

1. Indicate the location where the contamination occurred.
2. Indicate what amount of material is being handled.
3. Specify what contaminants are present in the material. List the percentage of the total contaminants each
substance makes up and indicate the volatility of each substance. Indicate the maximum concentration of each
contaminant in pounds per ton of material contaminated.
4. Specify where and how the remediation will be preformed.
5. Specify what method of remediation will be used.
6. Attach a flow diagram and site plan to this application.
7. Indicate the horse power or the cubic feet per minute rating of the fan/blower.
8. Supply the exhaust gas flow rate at design maximum and the average expected.
9. Indicate what type of fuel will be used in the heater.
10. Indicate whether or not air flow control valves will be used.
11 State the stack height, diameter, and gas exit temperature.
12. Supply the expected concentration flow rate in grams per second.
13. Indicate whether or not pressure gauges will be used.
14. Indicate whether or not flow meters will be used.
15. Attach a plan for monitoring discharge.
16. Indicate what type of nutrients will be added to soil for biodegradation.
17. Supply the water flow rate for water biodegradation.
18. Indicate the horse power or the cubic feet per minute rating of the fan/blower.
19. Indicate the number of recovery and number of injection wells on site.
20. Indicate what surfactant is being used in the leaching process.
21. Indicate the horse power or the cubic feet per minute rating of the pump.
22. Indicate what the leachate flow rate through the system is at design maximum and average expected.
23. Supply the number of monitoring wells used.
24. Describe how the leachate will be treated after it goes through the system.
25. Indicate what type of thermal treatment equipment will be used.
26. Indicate what company will be performing the thermal treatment and what the number of their approval order is.
27. Indicate what the incineration capacity will be.
28. Indicate the location of aeration.
29. Supply the dimensions of the aerated layer.
30. Indicate what type of soil is contaminated.
31. Indicate how the soil will be turned.
32. Indicate the company using the contaminated soil in asphalt.
33. Indicate what approval order the company is operating under.
34. Flow rate of groundwater through system.
35. Type of treatment of groundwater.
36. Indicate the exhaust gas flow rate.
37. Indicate the concentration flow rate in the exhaust gas in grams/sec.
38. Supply the stack height, stack diameter, stack gas exit temperature.
39. Attach a plan for monitoring discharge.
40. Name the landfill where the excavated soil will be transported.
41. Indicate the control that will be used in the remediation. Submit the appropriate form for the control.
42. Supply calculations for all criteria pollutants and HAPs (speciate, please).

U:\aq\ENGINEER\GENERIC\Forms 2010\Form16 Soil & Groundwater Remediation.doc
Revised 12/20/10

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