DAQ-2024-010155

Utah Division of Air Quality
New Source Review Section Company_______________________
Site/Source_____________________
Form 11 Date___________________________
Internal Combustion Engines

Equipment Information

1. Manufacturer: __________________________

Model no.: __________________________

The date the engine was constructed or
reconstructed ________________________

2. Operating time of Emission Source:
average maximum
______ Hours/day ______ Hours/day
Days/week Days/week
______ Weeks/year ______ Weeks/year

3. Manufacturer's rated output at baseload, ISO hp or Kw
Proposed site operating range _____________________________ hp or Kw

Gas Firing
4. Are you operating site equipment on pipeline quality natural gas: □ Yes □ No

5. Are you on an interruptible gas supply:
□ Yes □ No
If "yes", specify alternate fuel:
_______________________________

6. Annual consumption of fuel:

_____________________________ MMSCF/Year

7. Maximum firing rate:
_____________________________ BTU/hr

8. Average firing rate:
_____________________________ BTU/hr
Oil Firing
9. Type of oil:
Grade number □ 1 □ 2 □ 4 □ 5 □ 6 Other specify ___________

10. Annual consumption: ______________ gallons

11. Heat content:______________ BTU/lb or
______________ BTU/gal

12. Sulfur content:___________% by weight

13. Ash content: ____________% by weight

14. Average firing rate: gal/hr

15. Maximum firing rate: gal/hr

16. Direction of firing: □ horizontal □ tangential □ other: (specify)

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Internal Combustion Engine
Form 11 (Continued)

Operation

17. Application:
□ Electric generation
______ Base load ______ Peaking
□ Emergency Generator
□ Driving pump/compressor
□ Exhaust heat recovery
□ Other (specify) ________________________

18. Cycle
□ Simple cycle
□ Regenerative cycle
□ Cogeneration
□ Combined cycle
Emissions Data

19. Manufacturer’s Emissions in grams per hour (gr/hp-hr): _______ NOX _______ CO ______ VOC
_______ Formaldehyde

20. Attach manufacturer's information showing emissions of NOx, CO, VOC, SOx, CH2O, PM10, PM 2.5 , CO2, CH4 and N2O
for each proposed fuel at engine loads and site ambient temperatures representative of the range of proposed
operation. The information must be sufficient to determine maximum hourly and annual emission rates. Annual
emissions may be based on a conservatively low approximation of site annual average temperature. Provide emissions
in pounds per hour and except for PM10 and PM2.5 parts per million by volume (ppmv) at actual conditions and corrected
to dry, 15% oxygen conditions.

Method of Emission Control:

□ Lean premix combustors □ Oxidation catalyst □ Water injection □ Other (specify)____________

□ Other low-NOx combustor □ SCR catalyst □ Steam injection

Additional Information

21. On separate sheets provide the following:

A. Details regarding principle of operation of emission controls. If add-on equipment is used, provide make and
model and manufacturer's information. Example details include: controller input variables and operational
algorithms for water or ammonia injection systems, combustion mode versus engine load for variable mode
combustors, etc.

B. Exhaust parameter information on attached form.

C. All calculations used for the annual emission estimates must be submitted with this form to be deemed
complete.

D. All formaldehyde emissions must be modeled as per Utah Administrative Code R307-410-5 using
SCREEN3.

E. If this form is filled out for a new source, forms 1 and 2 must be submitted also.

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INSTRUCTIONS – Form 11 Internal Combustion Engine

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 manufacturer, the model number and the date the engine was constructed or reconstructed.
2. Complete the fuel burning equipment's average and maximum operating schedule in hours per day, days per
week, and weeks per year.
3. Specify the manufacturer's rated output and heat rate at baseload corresponding to International Standard
Organization (ISO) conditions in megawatts (MW) or horsepower (hp). Also indicated what the proposed site
operating range is in megawatts or horsepower.
4. Indicate the origin of the gas used in the engine.
5. Indicate if the gas supply can be interrupted and what the backup fuel is in case this happens.
6. Specify what the annual consumption of fuel is in million standard cubic feet (MMscf).
7. Supply the maximum firing rate in BTU/hr.
8. Supply the average firing rate in BTU/hr.
9. Indicate the grade of oil being used.
10. Supply the annual consumption calculated in gallons of oil.
11. Indicate the heat content of the oil in BTU/lb or BTU/gal.
12. Indicate the sulfur content of the oil in percent by weight.
13. Indicate the ash content of the oil.
14. Supply the average firing rate of oil.
15. Supply the maximum firing rate of oil.
16. Indicate what the firing direction is.
17. Indicate what the engine will be used for.
18. Indicate what type of cycle the engine will have.
19. Indicate the manufacturer’s emissions rate in grams/hp-hr
20. Provide manufacturer's emission information for the engine. Also indicate what method of emission control to
be used.
21. Provide details of the operation of emission controls and exhaust parameter information.

f:\aq\ENGINEER\GENERIC\Forms 2010\Form11 Internal Combustion Engines.doc
Revised 12/20/10

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INTERNAL COMBUSTION ENGINE
FORM 11 (continued)
EMISSION SOURCES

Review of applications and issuance of permits will be expedited by supplying all necessary information requested on this form.

AIR CONTAMINANT DATA EMISSION POINT DISCHARGE PARAMETERS
STACK SOURCES (7) EMISSION POINT
(1)
CHEMICAL COMPOSITION
OF TOTAL STREAM
AIR
CONTAMINANT
EMISSION RATE

UTM COORDINATES OF
EMISSION PT. (6) EXIT DATA
NUMBER NAME
COMPONENT OR AIR
CONTAMINANT NAME
(2)

CONC.
(%V) (3)

LB/HR
(4)

TONS/YR
(5)

ZONE

EAST
(METERS)

NORTH
(METERS)

HEIGHT
ABOVE
GROUND
(FT)

HEIGHT
ABOVE
STRUCT.
(FT)

DIA.
(FT)

VELO.
(FPS)

TEMP.
(OF)

GROUND ELEVATION OF FACILITY ABOVE MEAN SEA LEVEL _______________ feet.
UTAH AIR CONSERVATION BOARD STANDARD CONDITIONS ARE 68O F AND 14.7 PSIA.

General Instructions for this form.
1. Identify each emission; point with a unique number for this plant site on plot plan, previous permits and emission inventory questionnaire. Limit emission point number to 8 character spaces. For each
emission point use as many lines as necessary to list air contaminant data. Typical emission point names are: heater, vent, boiler, tank, reactor, separator, baghouse, fugitive, etc. Abbreviations are OK.
2. Typical component names are: air, H2O, nitrogen, oxygen, CO2, CO, NOx, SOx, hexane, particulate matter (PM10 and PM2.5), etc. Abbreviations are OK.
3. Concentration data is required for all gaseous components. Show concentration in volume percent of total gas stream.
4. Pounds per hour. (#/hr) is maximum emission rate expected by applicant.
5. Tons per year (T/Y) is annual maximum emission rate expected by applicant, which takes into account process operating schedule.
6. As a minimum applicant must furnish a facility plot plan drawn to scale showing a plant benchmark, latitude and longitude correct to the nearest second for the benchmark, and all emission points dimensioned
with respect to the benchmark. Please show emission point UTM coordinates if known.
7. Supply additional information as follows if appropriate:
(a) Stack exit configuration other than a round vertical stack. Show length and width for a rectangular stack. Indicate if horizontal discharge with a note.
(b) Stack's height above supporting or adjacent structures if structure is within three "stack heights above ground" of stack.