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Virginia Administrative Code
Title 9. Environment
Agency 5. State Air Pollution Control Board
Chapter 510. Nonmetallic Mineral Processing General Permit

9VAC5-510-130. Application statement and notice of termination forms.

A. The required statement for initial applications shall be in the following form:



(please print or type)

1. Name of company:

2. Name of owner:

3. Name of plant:

4. Mailing address:

5. Plant site manager or contact:

6. Telephone number:

7. Registration number:

(new sites leave blank)

8. Project name:

9. Description of activity (minerals processed):

10. Primary standard industrial classification (SIC) code:

Secondary SIC codes:

11. County:

12. Location:

13. A spreadsheet and a plant layout or flow diagram for all emissions units at the nonmetallic mineral processing facility for which the application is submitted. The following information shall be included for each piece of equipment:

a. The total rated crushing capacity for all primary crushers at the facility.

b. A description of the equipment, including applicability of any standard of performance under 40 CFR Part 60, as follows:

(1) Widths of belt conveyors.

(2) Dimensions of the top screen and configuration (e.g., triple deck) of the screening unit.

(3) Rated capacity (ton/hr) of each crusher.

(4) Rated capacity (ton or ton/hr) of all other equipment not exempt from new source review program requirements.

c. A unique ID number.

d. The date the equipment was manufactured.

e. The dates any required performance testing was conducted and submitted to the regional director.

f. Total rated horsepower of all stationary diesel engines.

g. Maximum hours of operation or gallons of fuel to be consumed, for each stationary diesel engine.

h. A description and accounting of all emissions of regulated air pollutants from all emissions units or groups of emissions units. Emissions shall be determined in a manner acceptable to the department. Fugitive emissions shall be included in the application as provided in the spreadsheet.

14. Calculations on which the information in subdivision 14 h of this subsection is based to the extent not covered in the spreadsheet. Any calculations shall include sufficient detail to permit assessment of the validity of the calculations and to enable the department to verify the actual emissions and potential to emit for the stationary source. This may include, but not be limited to, the following:

a. Actual and potential emissions in tons per annual period for each emissions unit or group of emission units.

b. Information needed to determine emissions as follows: fuels, fuel use, raw materials, production rates, loading rates, and operating schedules.

c. Identification and description of air pollution control equipment and compliance monitoring devices or activities.

15. Attach to this application an aerial photo or scale map which clearly shows the property boundaries and plant site.


"I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering and evaluating the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations."

Signatures: Date:

Signatures: Date:

Name of persons signing above: (printed or typed)

(printed or typed)


For Department use only:

Accepted/Not accepted by: Date:

Required attachments:

1. Local government certification form (greenfield sites only)

2. Spreadsheet and a plant layout or flow diagram

3. Aerial photo or scale map

B. The required notice of termination shall be in the following form:



1. Nonmetallic mineral processing general permit number:

2. Reason for termination request (Choose one):

a. The emissions associated with facility have been eliminated.

b. The facility authorized by the general permit has been determined to be shutdown in accordance with 9VAC5-20-220.

c. A permit has been issued for the facility covered by the general permit issued under the provisions of 9VAC5 Chapter 80 (9VAC5-80).

3. On what date do you wish coverage under this general permit to terminate?

4. Facility owner


Mailing address:

City: State: Zip code:


5. Facility location



City: State: Zip code:

6. Certification:

"I certify under penalty of law that all emissions associated with the identified facility have been eliminated, that the facility authorized by the general permit has been determined to be shutdown in accordance with 9VAC5-20-220, or that a permit has been issued covering the facility under the provisions of 9VAC5 Chapter 80 (9VAC5-80). I understand that by submitting this notice of termination, I am no longer authorized to operate under the general permit. I also understand that the submittal of this notice of termination does not release an owner from liability for any violations of this permit under the Air Pollution Control Law."

Signatures: Date:


Name of persons signing above: (printed or typed)

(printed or typed)


Statutory Authority

§ 10.1-1308 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 19, Issue 3, eff. December 1, 2002; amended, Virginia Register Volume 40, Issue 5, eff. October 23, 2023.

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