Form Ice100 - Internal Combustion Engines
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1
2FORM ICE100
INTERNAL COMBUSTION ENGINES
Engine Manufacturer: ______________________________________
Brake Horsepower: ________ @_____RPM
Model Number: _______________________
Identification/Serial Number (if known): _______________________
Engine Family ____________________________
Date of Installation ___________
Date Engine was Manufactured __________
Cubic Inch Displacement: ______
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Engine Type:
4-Cycle
2-Cycle
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Aspiration Type:
Turbo Charged
Normal
After Cooled
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Fuel Type:
CARB Diesel
Gasoline
Natural Gas
If Gaseous Fueled:
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Alternative Diesel (specify) ______________________________________
Rich Burn
Lean Burn
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Other(specify)_________________________________________________
Fuel Usage Rate (if known) ________________________________________
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Is engine used for:
Prime Power
Emergency Standby Exclusively*
*
Emergency standby exclusively allows operation when there is an actual interruption of power by the serving utility, emergency
water pumping for flood control, fire fighting or water pressure. Operation allows up to 50 hours/year of operation for maintenance
purposes and 200 total hours/year of operation for emergency and maintenance purposes combined (The Diesel Air Toxics Control
Measure may restrict the engines maintenance hours further) .
Maximum number of hours of operation for which the permit is being requested (see note above):
_______
_______
_______
hours/day
hours/quarter
hours/year
Typical Load (% of hp) _______________
Typical Hours of Operation ___________________
Which of the following (if any) will be used to control emissions?
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Fuel injection timing retard
degrees retarded from normal
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Selective Catalytic Reduction
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Non-Selective Catalytic Reduction/3 Way Catalysts
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Other(specify)_________________________________________________________________________________
Equipment Driven by this Engine:
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Generator
KW rating_________
Compressor
Pump Specify Use ___________________
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Generator that drives a pump
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Other (specify) ________________________________________________________________________________
Emission Factors: Complete the Table below
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2
Pollutant
Emission factor
Units
Basis
NOx
ROC
NOx+ROC
CO
SOx
PM
1
Emission factors may be reported in g/bhp-hr, lb/gal, lb/mmbtu or lb/scf
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Such as, Manufacturer Data, Source Test, CARB/EPA Certification, EPA Document AP 42, etc…
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