Plant name:______________________
Stack information
height diameter of the
Emission point ID Emission source Area (Location)
(mt) stack (cm)
e.g. furnace (specifying the type of
e.g. Furnace, batch house,
furnace), batch house, vacuum pump, etc.
etc.
ck information Air emission abatement system
number of Air emission abatement O-I site specific air emission Air emission abatement
Air emission abatement
sampling system maintenance abatement procedure system technical data
system
point frequency reference sheet reference
e.g. none, ESP, bag filter,
ESP+DeNOx e.g. quarterly, yearly, etc.
m Exhaust gas monitoring
Air emission
Air emission abatement system Exhaust gas
Calibration Calibration Validated Pollutants monitored by
abatement system inspection and monitoring
frequency method(s) reference CEM
maximum flow allowed maintenance system
responsible
e.g. Particulate matter,
None/CEMS SOx , etc.
Exhaust gas monitoring system
Are portable
Portable analyzer Pollutant sensor Portable calibration
analyzer Portable analyzer type
manufacturer installed frequency
available?
Y/N
Contact information
Air emission monitoring Air emission Plant Responsible for
equipment maintenance and reporting communication with the Regulatory Agency Regulatory contact
calibration responsible responsible authority
Plant name:______________________
Regulated pollutant (add
Emission Actual Air emission limit values (make
any other relevant
Point ID sure to add the unit of measure)
pollutant)
Oxygen (%) used as
reference
Particulate Matter
Nitrogen Oxides (NOx)
Sulphur Oxides (SOx)
Hydrochloric acid (HCl)
Hydrogen fluoride (HF)
Heavy metals (e.g. V, Ni,
YY Cr, Se, Pb, Co, Sb, As, Cd)
Carbon dioxide (CO2)
Carbon monoxide (CO)
Oxygen (%) used as
reference
Particulate Matter
Nitrogen Oxides (NOx)
Sulphur Oxides (SOx)
Hydrochloric acid (HCl)
Hydrogen fluoride (HF)
Heavy metals (e.g. V, Ni,
ZZ Cr, Se, Pb, Co, Sb, As, Cd)
Carbon dioxide (CO2)
Carbon monoxide (CO)
Oxygen (%) used as reference
Particulate Matter
Nitrogen Oxides (NOx)
Sulphur Oxides (SOx)
Hydrochloric acid (HCl)
Hydrogen fluoride (HF)
Heavy metals (e.g. V, Ni, Cr,
Se, Pb, Co, Sb, As, Cd)
WW Carbon dioxide (CO2)
Carbon monoxide (CO)
Future Air emission limit
Sampling method(s) Calculation method
values if available
Mandatory Spot analysis
reporting to the auhtority
frequency
e.g. quarterly, six-month, e.g. quarterly, six-month, yearly , xx days
yearly after the sampling, etc.
e.g. quarterly, six-month, e.g. quarterly, six-month, yearly , xx days
yearly after the sampling, etc.
e.g. quarterly, six-month, yearly , xx days after
e.g. quarterly, six-month, yearly the sampling, etc.
reference to the autority reporting form
GAP
Statutory actual or future air emission
Completed
operating condition
Y/N
In case answer is no
Is plant Is
Action plan By when Responsible Manager Country/Regional
informed EHS informed
