DAQ-2024-010163

Utah Division of Air Quality
New Source Review Section Company _______________________
Site/Source _____________________
Form 19 Date ___________________________
Natural Gas Boilers and Liquid Heaters

Boiler Information
1. Boiler Manufacturer: ___________________________________________________________________________
2. Model Number: ______________________________ 3. Serial Number: _______________________________
4. Boiler Rating: _________________(106 Btu per Hour)
5. Operating Schedule: __________ hours per day __________ days per week ___________ weeks per year
6. Use: □ steam: psig □ hot water □ other hot liquid: ________________________________
□ Natural Gas □ LPG □ Butane □ Methanol
□ Process Gas - H2S content in process gas __________ grain/100cu.ft.
7. Fuels:
□ Fuel Oil - specify grade: □ Other, specify: ______________________________________
Sulfur content % by weight Days per year during which unit is oil fired: ________________
Backup
Fuel □ Diesel □ Natural Gas □ LPG □ Butane □ Methanol □ Other _________________
8. Is unit used to incinerate waste gas liquid stream? □ yes □ no
(Submit drawing of method of waste stream introduction to burners)

Gas Burner Information
9. Gas Burner Manufacturer: _____________________________________________________________________
10. No. of Burners: ______________________________ 11. Minimum rating per burner: _____________ cu. ft/hr
12. Average Load: _______% 13. Maximum rating per burner: ____________ cu. ft/hr
14. Performance Guarantee (ppm dry corrected to 3% Oxygen):
NOx: ______________ CO: ______________ Hydrocarbons: ______________
□ Manual □ Automatic on-off 15. Gas burner mode of control:
□ Automatic hi-low □ Automatic full modulation

Oil Burner Information
16. Oil burner manufacturer:
17. Model: _______________ number of burners: _________________ Size number: _______________
18. Minimum rating per burner: _____________ gal/hr 19. Maximum rating per burner: ___________ gal/hr

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Page 2 of 3
Form 11 - Natural Gas Boiler and Liquid Heater
(Continued)

Modifications for Emissions Reduction
20. Type of modification: □ Low NOX Burner □ Flue Gas Recirculation (FGR)
□ Oxygen Trim □ Other (specify) ______________________________________

For Low-NOX Burners
21. Burner Type: □ Staged air □ Staged fuel □ Internal flue gas recirculation
□ Ceramic □ Other (specify): ___________________________________________________
22. Manufacturer and Model Number: _______________________________________________________________
23. Rating: ______________________ 106 BTU/HR 24. Combustion air blower horsepower: ____________
For Flue Gas Recirculation (FGR)
25. Type: □ Induced □ Forced Recirculation fan horsepower: ______________________________________
26. FGR capacity at full load: scfm %FGR
27. FGR gas temperature or load at which FGR commences: OF % load
28. Where is recirculation flue gas reintroduced? _______________________________________________________
For Oxygen Trim Systems
29. Manufacturer and Model Number: ________________________________________________________________
30. Recorder: □ yes □ no Describe: ____________________________________________________________

Stack or Vent Data
31. Inside stack diameter or dimensions ____________
Stack height above the ground ________________
Stack height above the building ________________
32. Gas exit temperature: ___________ OF
33. Stack serves: □ this equipment only, □ other equipment (submit type and rating of all other equipment
exhausted through this stack or vent)
34. Stack flow rate: _________________ acfm Vertically restricted? □ Yes □ No
Emissions Calculations (PTE)
35. Calculated emissions for this device
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_________ Lbs/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 19 – Natural Gas Boiler and Liquid Heater

This application form is applicable to natural gas-fired boilers and liquid heaters. Boiler(s) rated for a total of less than five
million Btu per hr and fueled by natural gas and one million Btu per hour and fired by fuel oil numbers 1-6 are exempt from filing
a Notice of Intent to construct. See Source Category Exemptions R307-401-10 (1) and (2).

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!
3. Attach specification sheets for all burners, equipment and modifications to boiler.

1. Company name of manufacturer of boiler (specifically the pressure vessel or shell).
2. Manufacturer's model number.
3. Specific identification, serial, number of the boiler.
4. The maximum heat input for which the boiler is rated. Give the value in million British thermal units per hour.
5. The operating schedule for which you want to be permitted. The air quality impact will be evaluated according to this
schedule. Note: The approval order will limit operating hours to what you request.
6. Mark the box indicating the purpose of the boiler.
7. Mark all fuels that you wish to be approved to use, also list the backup fuel to be used if any.
8. If a waste stream is burned, answer yes and submit drawings, etc. to characterize the method.
9. Company name of manufacturer of gas burners. If the boiler is a packaged boiler, list the manufacturer of the boiler.
10. How many gas burners will be installed in the boiler?
11. Minimum gas flow rate at which each burner can operate (in cubic feet per hour)
12. The average load at which you plan to operate each burner, compared to the maximum burner rating.
13. Maximum gas flow rate at which each burner can operate (in cubic feet per hour)
14. List the maximum concentration which the manufacturer guarantees the burners will produce in parts per million of
Nitrogen Oxides (NOX), Carbon Monoxide (CO), and Total Hydrocarbons. If the percentage of Non-methane
hydrocarbons is known, please provide that information.
15. Indicate the method used to control the flame for the burners.
16. Company name of manufacturer of oil burners. If the boiler is a packaged boiler, and has duel fuel capability, list the
manufacturer of the boiler.
17. Manufacturer's model, number (quantity), and size of oil burners to be installed in the boiler.
18. Minimum oil flow rate at which each burner can operate (in gallons per hour).
19. Maximum oil flow rate at which each burner can operate (in gallons per hour).
20. Indicate the type of emissions reduction strategy(ies) used in the proposed boiler.
21. Indicate the low-NOX strategy used in the burner design.
22. Company name of manufacturer of the burners. Manufacturer's model number for the burners.
23. The heat input rating of each burner in million British thermal units per hour.
24. In a forced draft design, the horsepower of the fan motor used.
25. Method for delivering the flue gas to the combustion zone. Forced draft indicates the presence of a fan. Give the fan
horsepower if so equipped.
26. The amount of flue gas which can be recirculated, in standard cubic feet per minute. And the percentage of the flue
gas that can be recirculated at full load.
27. Generally, flue gas recirculation systems start up at a given load or temperature. Give that specification.
28. Where in relation to the burner/combustion zone is the flue gas reintroduced to the boiler?
29. Name of the manufacturer and the model number of the oxygen trim system.
30. Is there a data recorder? If so, describe it: What is recorded? How is it read?
31. Give the inside diameter or the dimensions of the stack. List the stack height above the ground and above the
building in which it is located, describe if the gas flow is vertically restricted. This information will be used in modeling
the impact of emissions on the ambient air.
32. Give the expected gas exit temperature at the end of the stack. Also to be used in modeling.
33. Indicate if other equipment is also vented to this stack. If other equipment is served by the stack, provide the flow
rates, operating parameters, fuel and combustion information that can be used to characterize the total emissions
from the stack.
34. Give the gas flow rate out of the stack in actual cubic feet per minute (acfm).
35. Supply calculations for all criteria pollutants, greenhouse gases and HAPs. Use AP42 or Manufacturers’ data to
complete your calculations.

U:\aq\ENGINEER\GENERIC\Forms 2010\Form19 Natural gas-Fired Boilers and Liquid Heaters.doc Revised 12/20/10