This checklist is intended to help applicants prepare a complete application without major deficiencies. A complete application submitted with the information listed below will enable a faster review. This is an electronic fill-able form and instructions throughout this document appear in this color.

Section A: Facility Information

facility name:	pi:	date (mm/dd/yyyy):
minor facility - preconstruction permit (n.j.a.c. 7:27-8) major facility - operating permit (n.j.a.c. 7:27-22)
is the facility located in (check one): camden waterfront south newark ironbound other

Section B: Type of Application

addition of new equipment modification of existing equipment - existing activity: other
enforcement relevance this modification is a result of pending enforcement action there are pending enforcement actions related to this equipment none

Section C: State Rules Applicability

new jersey air pollution control rules	applicable	affected equipment (provide E# only)	affected emission units* (provide U# only)
7:27-3 Control and Prohibition of Smoke from Combustion of Fuel
7:27-4 Control and Prohibition of Particles from Combustion of Fuel
7:27- 5 Prohibition of Air Pollution (includes odor provisions)
7:27- 6 Control and Prohibition of Particles from Manufacturing Processes
7:27-7 Sulfur (from manufacturing)
7:27-9 Sulfur In Fuels (liquid and gaseous)
7:27-10 Sulfur In Solid Fuels
7:27-11 Incinerators
7:27-16 Control and Prohibition of Air Pollution by Volatile Organic Compounds
7:27-17 Control and Prohibition of Air Pollution by Toxic Substances
7:27-18 Control And Prohibition of Air Pollution from New or Altered Sources Affecting Ambient Air Quality
7:27-19 Control and Prohibition of Air Pollution from Oxides of Nitrogen
7:27-20 Used Oil Combustion
7:27-27 Control and Prohibition of Mercury Emissions

* emission unit information is required only for operating permit modifications.

Section D: Risk Screening - applies to new or modified equipment only

no hap emissions above reporting threshold as listed in n.j.a.c. 7:27-17. risk screening is not required. hap emissions are above reporting threshold – enter affected emission unit/equipment below. health risk screening is required consistent with tech manual 1003 available at: http://www.state.nj.us/dep/aqpp/risk.html
affected emission units:	affected equipment:

Section E: Air Quality Modeling Analysis

check all that apply this application is subject to psd air quality impact analysis requirements set forth at 40 CFR 52.21. this application is subject to the air quality impact analysis requirements set forth at N.J.A.C. 7:27-18.4. this modification includes source operations which, based on screening procedures published in technical manuals (http://www.nj.gov/dep/aqpp/techman.html) by the department, have the potential to cause any of the adverse air quality effects consistent with N.J.A.C. 7:27-22.8(a)4. any other state or federal rule requires that an air quality impact analysis be performed. air quality modeling analysis is required if any of the items above apply. check the appropriate box below. air quality modeling analysis is required air quality modeling analysis is not required in addition to the above, the department may also determine that an air quality impact analysis is required.

Section F: Advances In The Art Of Air Pollution Control

check all that apply: emissions of criteria pollutant above 5 tons for each equipment being modified (pte after control) hap emissions (pte), for each equipment being modified, above sota thresholds in N.J.A.C. 7:27-8 if any box is checked above, enter the pollutants and affected emission unit/equipment in table 1 below not applicable
TABLE 1	affected source	sota compliance method - check for each listed equipment
pollutant*	equipment	emission unit**	laer	bact	mact or gact	sota manual	case by case sota

*for additional items, use attachment item 5. **emission unit information is required only for operating permit modifications.

Section G: Federal Rules Applicability

federal rules	applicable	affected emission units	affected equipment
40 CFR 60 New Source Performance Standards (NSPS)
40 CFR 61 National Emission Standard for Hazardous Air Pollutants (NESHAP)
40 CFR 63 Maximum Achievable Control Technology (MACT)
40 CFR 64 Compliance Assurance Monitoring (CAM)
40 CFR 52.21 Prevention of Significant Deterioration (PSD) - use attachment items 3 & 4

Section H: Comments / Notes

use this space to provide any comments regarding this application

Section I: Attachments

a brief description of the process is attached

a block/air flow diagram of the process is attached

emission calculations are attached

stack test data from similar units is attached (if available)

is coordination required with other njdep programs for this modification

list here:

any other attachments - list here:

facility name:	pi:	date (mm/dd/yyyy):

TABLE 1 – continued	affected source	sota compliance method - check the box for each listed equipment
pollutant	emission unit	equipment	bact	laer	mact or gact	sota manual	case by case