HomeMy WebLinkAboutDAQ-2024-010186SAMPLE COMPLIANCE CERTIFICATION REPORT revised May 17, 2005
Page 1 of 4
TO: Executive Secretary, Utah Air Quality Board
FROM: Source name as indicated on the permit
RE: Annual Compliance Certification for Permit #
DATE:
In accordance with Operating Permit provision I.L and Utah Administrative Code (UAC) R307-415-6c(5), the following compliance certification is submitted.
This certification covers operations from ___/___/___ to ___/___/___.
(Note: The certification period must be consecutive to the last certification, and cannot cover more than one year. Be sure to submit by the date in your permit!)
Term Description of permit provision
Method used to determine
compliance status
Was compliance
during report period
continuous,
intermittent or
undetermined?
Other info relevant to compliance status,
including references to any and all
deviations; reason for “undetermined” status;
any excursions or exceedances (for CAM
provisions only); etc.
I.B Was the source operated in
compliance with the operating
permit?
I.C.3 Did the permittee furnish
information requested by the
Executive Secretary?
I.G.1 Did the permittee pay the annual
emission fee?
I.G.2 Was the fee paid on time?
I.K Were all application forms, reports
and certifications submitted
pursuant to the permit properly
certified by a responsible official?
I.L.1 Did the permittee submit this
compliance certification complete &
on time?
I.L.2 Did the permittee also send all
compliance certifications to EPA?
I.S.1.a Did the permittee properly retain all
records required by the permit?
SAMPLE COMPLIANCE CERTIFICATION REPORT revised May 17, 2005
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Term Description of permit provision
Method used to determine
compliance status
Was compliance
during report period
continuous,
intermittent or
undetermined?
Other info relevant to compliance status,
including references to any and all
deviations; reason for “undetermined” status;
any excursions or exceedances (for CAM
provisions only); etc.
I.S.1.b Did the permittee include all
applicable information in records of
monitoring required by the permit?
I.S.2.a Did the permittee submit monitoring
reports every six months, or more
frequently if specified in Section II,
and were all instances of deviation
from permit requirements clearly
identified in the monitoring reports?
I.S.2.c Did the permittee promptly notify the
Executive Secretary of all deviations
from permit requirements?
I.U Did the permittee submit the
inventory required by R307-150 in
accordance with the requirements
of that rule? (This covers R307-150,
155 and 158 if listed in permit)
II.B.x Each provision in Section II.B,
including each monitoring,
record keeping, and reporting
requirement
SAMPLE COMPLIANCE CERTIFICATION REPORT revised May 17, 2005
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Term Description of permit provision
Method used to determine
compliance status
Was compliance
during report period
continuous or
intermittent?
Other facts relevant to compliance status,
including references to any and all deviations
IV.B.2.a Did the permittee operate each
affected unit in compliance with a
complete Acid Rain permit
application or permit?
IV.C.1.a Did the permittee hold the required
allowances as of the allowance
transfer deadline?
IV.C.1.b Did the permittee comply with the
applicable Acid Rain emissions
limitations for sulfur dioxide?
IV.C.5 Did the permittee deduct any
allowance prior to the calendar
year for which it was allocated?
IV.D.x Did the permittee comply with the
applicable NOx requirements? (Any
term under IV.D that contains
emission limits must be certified;
early election and averaging plan
conditions need not be certified.)
IV.E.1 Did the permittee comply with the
monitoring requirements in 40 CFR
74, 75 and 76?
IV.F.1 Did the permittee properly retain all
listed documents?
IV.F.2 Did the designated representative
submit all reports and compliance
certifications required under the
Acid Rain program?
IV.G.1 Did the designated representative
submit a proposed offset plan if
required?
IV.G.2.a Did the permittee pay penalties
and interest as required?
IV.G.2.b Did the permittee comply with
terms of an approved offset plan?
SAMPLE COMPLIANCE CERTIFICATION REPORT revised May 17, 2005
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Certification
In accordance with Operating Permit provision I.K and UAC R307-415-5d, and based on information and belief formed after reasonable inquiry, I certify that the
statements and information in this document are true, accurate, and complete.
Signature of a Responsible Official for the Source Date
Print or type the name and title of Responsible Official