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OAQ PROCESS INFORMATION APPLICATION PI-21: Site Remediation
State Form 52570 (R / 1-07)

INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT

IDEM ­ Office of Air Quality ­ Permits Branch 100 N. Senate Ave., MC 61-53 Indianapolis, IN 46204-2251 Telephone: (317) 233-0178, or Toll Free: 1-800-451-6027 x30178 (within Indiana) Facsimile Number: (317) 232-6749 www.idem.IN.gov/permits/air/index.html

NOTES:

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The purpose of this form is to obtain detailed information about the remediation process. Complete one form for each process unit (or group of identical process units). This is a required form. Detailed instructions for this form are available online at

www.idem.IN.gov/permits/air/apps/instructions/pi21instructions.doc .
All information submitted to IDEM will be made available to the public unless it is submitted under a claim of confidentiality. Claims of confidentiality must be made at the time the information is submitted to IDEM, and must follow the requirements set out in 326 IAC 17.1-4-1. Failure to follow these requirements exactly will result in your information becoming a public record, available for anyone to inspect and photocopy.

PART A: Process Information Part A identifies the remediation process. If there are multiple process units that are identical in nature, capacity, and use, you may use one form to summarize the data for the identical process units. 1. Unit ID: 3. How many (identical) process units are identified in this form? 4. Method of Remediation: 5. Total Organic Contamination (specify units): 6. Estimated Remediation Time (days): 7. Maximum Water Flowrate (gpm): 8. Maximum Air Flowrate (acfm): 9. Add-On Control Technology: Identify all control technologies used for this unit, and attach completed CE-01 (unless "none"). None Wet Scrubber / Absorption ­ Attach CE-05. Other (specify): ­ Attach CE-10. 2. Installation Date:
(actual or anticipated)

One Air Sparging

More than one (specify number) : Air Stripping Bioremediation

10. Control Techniques: Identify all control techniques used for this process.

11. Process Limitations / Additional Information: Identify any acceptable process limitations. Attach additional information if necessary.

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Indiana Department Of Environmental Management Office Of Air Quality State Form 52570 (R / 1-07)

Process Information ­ Site Remediation FORM PI-21 Page 2 of 2

PART B: Emission Factors Part B identifies all emission factors used to calculate air emissions from this process. 12. Process Unit
(& ID, if applicable)

13. Air Pollutant

14. Emission Factor
value units

15. Source of Emission Factor
(if not using AP-42, include calculations)

AP-42 AP-42 AP-42 AP-42 AP-42 AP-42

Other Other Other Other Other Other

PART C: Soil / Groundwater Contaminants Part C identifies the soil or groundwater contaminants that are to be removed. 16. Chemical Name: 17. Chemical Abstract Service (CAS) Registry Number 18. Concentration
µg/L ppm

PART D: Federal Rule Applicability Part D identifies any federal rules that apply to the process. 19. Is a New Source Performance Standard (NSPS) applicable to this source? If yes, attach a completed FED-01 for each rule that applies. 40 CFR Part 60, Subpart
(Specify):

Yes

No

20. Is the National Emission Standard for Hazardous Air Pollutants (NESHAP) for Site Remediation (40 CFR Part 63, Subpart GGGGG) applicable to this source?
Attach a completed FED-01 if this rule is applicable.

Yes

No

21. Non-Applicability Determination: Provide an explanation if the process unit appears subject to a rule (based on the rule title or the source category), but the rule will not apply.