Title Page

  • Company Name

  • Prepared by

  • Conducted on

  • Location
  • Has upper-management been informed of all contact between on-site personnel and regulatory agencies?

  • Has every source of air contaminants been identified?

  • Is there an emissions inventory of actual and potential emissions from each source of air contaminants?

  • Is the facility located in a non-attainment area?

  • Is the facility a “major source”?

  • Is the facility a “synthetic minor source”?

  • Is the facility a “natural minor source”?

  • Does the facility/all sources of air contaminants that require permits under federal, state, or local regulations have the appropriate construction and/or operating permits?

  • Has the facility implemented any production changes that would alter its air emissions and thus the conditions under which any air quality permit was issued?

  • If the facility has had any changes affecting air emissions, has the facility submitted the necessary permit applications to account for the change?

  • Is every source of air contaminants at the facility in compliance with the terms and conditions of the permit issued for that source?

  • Is the air emissions inventory being compiled according to the frequency outlined in any applicable permit condition?

  • Is every source of air contaminants at the facility in compliance with the applicable federal, state, and local air quality regulations?

  • Is emissions control equipment being maintained properly?

  • Do the appropriate workers have adequate knowledge of the permit conditions and applicable federal, state, and local air quality regulations?

Sign off

  • Inspector's name and signature

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