(a) Emission statements shall include the following:

1. (1) Certification by a responsible official. A responsible official must sign a form or other legal instrument provided by the department to certify the emission statement information. This certification shall state that after reasonable inquiry, the responsible official has concluded that the statements and information in the document are accurate and complete in accordance with this Subpart, based on the best available information. The certification shall include the full name, title, original signature, date of signature, e-mail address and telephone number of the responsible official.

2. (2) Facility level information, consisting of:

   1. (i) full name of facility;
   2. (ii) owner's name;
   3. (iii) street address (physical location) of the facility;
   4. (iv) four-digit primary SIC code or NAICS for the facility;
   5. (v) calendar year for which emissions are being reported; and
   6. (vi) total facility fuel use, average sulfur content, average ash content and heat value (for combustion installations).

3. (3) Process level information, consisting of:

   1. (i) process identification;
   2. (ii) eight-digit SCC for the process;
   3. (iii) annual throughput or quantity of fuel consumed (combustion sources);
   4. (iv) description of the process;
   5. (v) description of installed air pollution control equipment;
   6. (vi) the average number of hours of operation per day (including annual, peak ozone season and peak carbon monoxide season in carbon monoxide nonattainment or maintenance areas);
   7. (vii) the average number of days of operation per week (including annual, peak ozone season and peak carbon monoxide season in carbon monoxide nonattainment or maintenance areas);
   8. (viii) the number of weeks per year of operation (including annual, peak ozone season and peak carbon monoxide season in carbon monoxide nonattainment or maintenance areas);
   9. (ix) percent operation by season, January, February, and December; March-May; June-August; September-November (percent fuel use by season for combustion sources). The sum of the four seasons must equal 100 percent;
   10. (x) total days of operation (during the peak ozone season, June-August, and peak carbon monoxide season, January, February, and December, in carbon monoxide nonattainment or maintenance areas);
   11. (xi) control efficiencies achieved by the air pollution control equipment. The control efficiency should reflect the total control efficiency from all control equipment for a specific air contaminant (e.g., VOCs, NO_x). If the actual control efficiency is unavailable, the design efficiency or the control efficiency limit imposed by a permit shall be used;
   12. (xii) annual reportable process emissions, for each regulated air contaminant emitted, (in units of pounds per year). Emissions of individual contaminants (identified by CAS code) less than 10 pounds per year may be reported on a process basis as less than 10 pounds. For purposes of calculating emission fees, contaminants reported as less than 10 pounds will be treated as though 10 pounds of the contaminant were emitted. Reporting of emissions for processes with source classification codes beginning with 1 or 2 is optional. In such cases, the department will calculate process-level emissions based upon the reported fuel use and published emission factors;
   13. (xiii) annual reportable fugitive emissions. A facility must estimate fugitive emissions which are generated from its operation. A facility may aggregate fugitive emissions under a single process to account for total facility fugitive emissions where the origin of such emissions cannot be identified. The facility must indicate such aggregation has occurred on its emission statement;
   14. (xiv) emissions estimate method (see section 202-2.4[d] of this Subpart);
   15. (xv) emission factors and source from where the emission factor was obtained (if used to determine actual emissions);
   16. (xvi) start time (hour); and
   17. (xvii) work weekday emissions.

(c) A facility is required to report actual emissions for each contaminant listed on its title V operating permit. A facility must also report its actual emissions of each of the following contaminants:

1. (1) sulfur oxides (SO₂);
2. (2) volatile organic compounds (VOCs);
3. (3) nitrogen oxides (NO_x);
4. (4) carbon monoxide (CO);
5. (5) lead and lead compounds (Pb);
6. (6) primary PM_2.5 (includes filterable and condensable);
7. (7) primary PM₁₀ (includes filterable and condensable);
8. (8) ammonia (NH₃);
9. (9) hazardous air pollutants (HAPs) reported at the CAS registry number level, as defined in Part 200 of this Title;
10. (10) Carbon dioxide (CO₂);
11. (11) Methane (CH₄);
12. (12) Nitrous oxide (N₂O);
13. (13) Hydrofluorocarbons (HFCs);
14. (14) Perfluorocarbons (PFCs);
15. (15) Sulfur hexafluoride (SF₆); and
16. (16) any regulated air contaminant.

(f) As part of the periodic inventory, the department shall provide additional forms and instructions to facilities in order to verify or collect the following information for permitted activities in the Title V permit:

1. (1) X stack coordinate (longitude);
2. (2) Y stack coordinate (latitude);
3. (3) stack height;
4. (4) stack diameter;
5. (5) exit gas temperature;
6. (6) exit gas velocity;
7. (7) exit gas flow rate;
8. (8) design capacity; and
9. (9) maximum nameplate capacity.