Form 3828 - Application For Air Pollution Control Tax Exemption Certificate Page 3

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3828, Page 3

TE-PROCESS

Application for Air Pollution Control Tax Exemption Certificate

Process Change Description - Complete only if changing a current process to a new improved process

PART 6: ORIGINAL PROCESS AND ALTERNATIVE (THEORETICAL) CONVENTIONAL CONTROL

27. AQD Source ID (SRN)

28. Emission Unit

29. Describe the original process and the operational procedure of this emission unit, with specific attention paid to the portion(s) of the process being

changed. (A detailed narrative is critical.)

30. Describe or list the air pollution control devices employed by the original process.

31. Describe the type and magnitude of pollutants associated with this emission unit.

32. Permit Number/ Permit

Exemption Rule (must provide

one)

33. Describe a control device that could have been employed to reduce emissions to the same extent as the process

33a. Estimated cost of

change. Give details concerning whether or not it could (physically) have been done, and whether or not it would be

theoretical/conventional control

as effective as the process change at controlling pollution. (See Example 1 in instructions). (33 and 33a must be

completed)

PART 7: NEW PROCESS -

The shaded area in items 43 and 44 are for Office Use Only.

34. Describe the process and the operational procedure of this emission unit, with specific attention being paid to the portion(s) of the process that

were/are being changed. Provide plans, specifications and drawings showing position of equipment relative to outer shell of building.

35. Describe the air pollution control devices employed by the new process. IMPORTANT: A TE-EQUIPMENT form should be submitted for

equipment that is solely used for air pollution control.

36. Describe the type and magnitude of pollutants associated with this new emission unit.

38. Permit Number/ Permit

37. Emission Unit

39. Beginning Date of

40. Projected/Actual Completion

Exemption Rule (if different from

Construction

item 28)

41. Total Cost of Process Change