DAQ-2024-010156

Utah Division of Air Quality
New Source Review Section Company _____________________
Site/Source_______________________
Form 12 Date _______________________
Incinerators

General Information
1. Attach process diagrams of the incinerators described on this form
2. Describe the source of waste:

3. Manufacturer of incinerator:

4. Model name and number:
5. Type of incinerator: □ Flue □ Single Chamber
□ Multiple Chamber
6. Maximum amount of waste to be incinerated:
____________lb/hr
7. Estimated daily amount of waste to be
incinerated:_________lb
8. Height of stack above grade:__________ft
9. Height of tallest structures within 150 feet:

Feet
10. Primary burner used: □ Yes □ No
Maximum rating __________ BTU/hr
11. Secondary Burner used: □ Yes □ No Maximum rating _______________BTU/hr
Description of Typical Waste to Be Incinerated

12. Type of waste to be incinerated:
□ Type 0 Trash with 8,500 BTU/lb □ Type 4 Human and animal parts, with 1,000 BTU/lb
85% moisture, 5% incombustible 10% moisture, 5% incombustible
□ Type 1 Rubbish with 6,500 BTU/lb □ Type 5 Industrial by-product wastes which are gaseous,
25% moisture, 10% incombustible liquid, & semi-liquid
□ Type 2 Refuse with 4,300 BTU/lb □ Type 6 Industrial solid byproduct waste rubber,
50% moisture, 7% incombustible plastic, wood wastes
□ Type 3 Garbage with 2,500 BTU/lb □ Type 7 Municipal sewage sludge wastes residue
70% moisture, 5% incombustible from processing of raw sludge

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Incinerator
Form 12 (Continued)

Operational Information
13. Average operation time of incinerator: _____ hrs/day ______ days/week ______ weeks/year
14. Maximum operation time of incinerator: _____ hrs/day ______ days/week ______ weeks/year
15. Average Temperature: Primary ______ oF Secondary ______ oF
16. Residence time: Primary: _______seconds Secondary: _______ seconds
17. Type of feed to incinerator: □ Manual □ Ram □ Other _____________________________
18. Proposed Control Technology:
□ Quench Tower
□ Heat Exchanger
□ Dry Scrubber (attach DAQ Form 9)
□ Wet Scrubber (attach DAQ Form 9)
□ Baghouse (attach DAQ Form 10)
Emission Information
19. Number of identical sources (describe)

20. Average Operation

Pollutants

Concentration or emission rate per identical source

Method used to determine
concentration or emission rate
Particulate matter
(PM10) gr/dscf □ lb/106 BTU □ lb/hr

Particulate matter
(PM2.5) gr/dscf □ lb/106 BTU □ lb/hr
Carbon monoxide
(CO) ppm (vol) □ lb/106 BTU □ lb/hr

Nitrogen oxides
(NOx) ppm (vol) □ lb/106 BTU □ lb/hr

Volatile organic
Compounds (VOCs) ppm (vol) □ lb/106 BTU □ lb/hr

Sulfur dioxide (SO2) ppm (vol) □ lb/106 BTU □ lb/hr

Carbon dioxide
(CO2) ppm (vol) □ lb/106 BTU □ lb/hr
Methane (CH4) ppm (vol) □ lb/106 BTU □ lb/hr
Nitrous oxide (N2O) ppm (vol) □ lb/106 BTU □ lb/hr

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Incinerator
Form 12 (Continued)

Maximum Operation
Contaminant Concentration or Emission Rate per Identical Source Method used to determine
concentration or emission rate
Particulate matter
(PM10) gr/dscf □ lb/106 BTU □ lb/hr

Particulate matter
(PM2.5) gr/dscf □ lb/106 BTU □ lb/hr
Carbon monoxide
(CO) ppm (vol) □ lb/106 BTU □ lb/hr

Nitrogen oxides
(NOx) ppm (vol) □ lb/106 BTU □ lb/hr

Volatile organic
Compounds (VOCs) ppm (vol) □ lb/106 BTU □ lb/hr

Sulfur dioxide (SO2) ppm (vol) □ lb/106 BTU □ lb/hr

Carbon dioxide CO2) ppm (vol) □ lb/106 BTU □ lb/hr
Methane (CH4) ppm (vol) □ lb/106 BTU □ lb/hr
Nitrous oxide (N2O) ppm (vol) □ lb/106 BTU □ lb/hr
Metals (Maximum Operation)
Arsenic pounds/hour Manganese pounds/hour
Barium pounds/hour Mercury pounds/hour
Cadmium pounds/hour Nickel pounds/hour
Hexavalent chromium pounds/hour Selenium pounds/hour
Total chromium pounds/hour Silver pounds/hour
Copper pounds/hour Tin pounds/hour
Lead pounds/hour Dioxins/furans pounds/hour
21. Exhaust Point Information
Flow diagram designation(s) of exhaust point(s):
Description of exhaust point (location in relation to buildings, direction, hooding, etc.):
Exhaust height above grade: Feet Exhaust diameter: Inches
Greatest height of nearby buildings: Feet Exhaust distance from nearest plant boundary: Feet
Average Operation Maximum Operation
Exhaust gas temperature: °F Exhaust gas temperature: °F
Gas flow rate through each exhaust point: Gas flow rate through each exhaust point:

Instructions - Form 12 Incinerator

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. Attach flow diagram of the described incinerator.
2. Please describe the source of waste to be incinerated.
3. Supply the name of the manufacturer of the incinerator.
4. Supply the model and number of the incinerator.
5. Indicate the type of incinerator.
6. Specify the maximum amount of waste to be incinerated.
7. Specify the daily amount of waste to be incinerated.
8. Indicate the height of the stack above ground level.
9. Indicate the height of tallest structure within 150 feet.
10. Supply the specifications for primary burner used.
11. Supply the specifications for secondary burner used.
12. Indicate the type of typical waste to be incinerated.
13. Supply the average operation time of the incinerator.
14. Supply the maximum operation time of the incinerator.
15. Supply the average temperature in the primary and secondary chambers.
16. Supply the residence time in the primary and secondary chambers.
17. Indicate what type of feed is used to load the incinerator.
18. Indicate the control technology to be use. Submit the corresponding form, if available, for the control
technology. Submit specifications for control technology which a form is not available for. Forms
available are the following:

Form 3 Afterburners
Form 4 Flares
Form 5 Adsorption Unit
Form 6 Cyclone
Form 7 Condenser
Form 8 Electrostatic Precipitators
Form 9 Scrubber
Form 10 Fabric Filter

19. Indicate how many incinerators units are being used.
20. Specify the concentration or emission rate of the listed contaminants for both the average and
maximum feed rate.
21. Supply the exhaust specifications listed.

U:\aq\ENGINEER\GENERIC\Forms 2010\Form12 Incinerators.doc
Revised 12/20/10

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