DAQ-2025-001437

NMOC EMISSION RATE REPORT DATE: _________________ State of Utah
Department of Environmental Quality
__ Initial Division of Air Quality
__ Amended PO. Box 144820
Salt Lake City, UT 84114-4820
1. Landfill Name ____________________________________ Telephone: [phone]
2. Landfill Owner/Operator Name: Contact Name:
Street: Title:
City, State, Zip: Telephone:
Fax:
3. [ ] Please check if mailing address for this landfill is the same as the mailing address given above. If different mailing address
for this landfill, please complete the following:
Site Address: Name: _______________________
Street: _______________________
City, State: ___________________ Zip: ___________
4. Location information: County: 5. Year landfill began accepting waste
_________
Latitude: UTM East:
Longitude: UTM North: Year landfill closed _________
6. Total amount of refuse in place as of December 31, 199_ [ ] Mg 7. Type of collection system (i.e., active
__________________________________________ [ ] Tons vertical)
[ ] yd3 _____________________________
Approximate amount of refuse received each year [ ] m3
__________________________________________
8. Control device (i.e., flare, IC engine) ________________________________
Control Code ________________________________
9. Values Used in Calculation if other than 40 10. Total NMOC emission from January 1, 199_ to December 31, 199_
CFR Part 60 Subpart WWW defaults _____________ [ ] tone/year [ ] Mg/year
k __________ Lo _________ (Use of 40 CFR Part 60 Subpart WWW defaults required for initial
reports. Tier II and III testing can be used for amended reports if DAQ
NMOC Concentration __________ approved)
(Submit test results with form) ATTACH CALCULATIONS OR MODEL RUN
11. Name (type or print) _________________________ Title: ______________________________

Signature: ___________________________________ Date: ______________________________