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pdfUnited States Environmental Protection Agency
Acid Rain, MATS, and Cross-State Air Pollution Rules
OMB Nos. 2060-0258 and 2060-0667
Approval Expires 12/31/2018
Certificate of Representation
For more information, see instructions and 40 CFR 63 subpart UUUUU, 72.24, 97.113, 97.213, 97.313, 97.416,
97.516, 97.616, 97.716, or a comparable state regulation, as applicable.
This submission is:
STEP 1
Provide
information for
the plant.
□
New
□
Revised (revised submissions must be complete; see instructions)
Plant Name
State
Plant Code
County Name
STEP 2
Enter
requested
information for
the designated
representative.
Latitude
Longitude
Name
Title
Company Name
Mailing Address
City
Phone Number
Fax Number
State
Zip Code
State
Zip Code
E-mail Address
STEP 3
Enter
requested
information for
the alternate
designated
representative.
Name
Title
Company Name
Mailing Address
City
Phone Number
Fax Number
E-mail Address
EPA Form 7610-1 (Revised 6-2016)
Certificate of Representation
Page 2 of 5
UNIT INFORMATION
STEP 4: Complete a separate page 2 for each unit located at the plant identified in STEP 1 (i.e., for each boiler, simple cycle combustion turbine, or combined cycle combustion
turbine) Do not list duct burners. Indicate each program to which the unit is subject, and enter all other unit-specific information. See instructions for more details.
Applicable Program(s):
Acid Rain
CSAPR NOx Ozone Season
CSAPR SO2 Annual
MATS
CSAPR NOx Annual
Generator
ID Number
(Maximum
8
characters)
Acid Rain Nameplate
Capacity (MWe)
MATS/Cross-State Air
Pollution Rule Nameplate
Capacity (MWe)
Source Category
Unit ID#
Unit Type
NAICS Code
Date unit began (or will begin) serving any generator producing electricity for sale (including test
generation) (mm/dd/yyyy):
Check One:
Projected
Actual
Is this unit located in Indian
Country?
Has this unit ever operated at another location?
Check One:
Check One:
Yes
No
Yes
No
Company Name:
Owner
Operator
Company Name:
Owner
Operator
Company Name:
Owner
Operator
Company Name:
Owner
Operator
Company Name:
Owner
Operator
Company Name:
Owner
Operator
EPA Form 7610-1 (Revised 6-2016)
Certificate of Representation
Page 3 of 5
STEP 5: Read the appropriate certification statements that apply (if), sign, and date.
Acid Rain Program
I certify that I was selected as the designated representative or alternate designated representative (as applicable) by an
agreement binding on the owners and operators of the affected source and each affected unit at the source (i.e., the source
and each unit subject to the Acid Rain Program, as indicated in "Applicable Program(s)" in Step 4).
I certify that I have all necessary authority to carry out my duties and responsibilities under the Acid Rain Program on behalf
of the owners and operators of the affected source and each affected unit at the source and that each such owner and
operator shall be fully bound by my representations, actions, inactions, or submissions.
I certify that the owners and operators of the affected source and each affected unit at the source shall be bound by any order
issued to me by the Administrator, the permitting authority, or a court regarding the source or unit.
Where there are multiple holders of a legal or equitable title to, or a leasehold interest in, an affected unit, or where a utility or
industrial customer purchases power from an affected unit under a life-of-the-unit, firm power contractual arrangement,
I certify that:
I have given a written notice of my selection as the designated representative or alternate designated representative (as
applicable) and of the agreement by which I was selected to each owner and operator of the affected source and each
affected unit at the source; and
Allowances, and proceeds of transactions involving allowances, will be deemed to be held or distributed in proportion to each
holder's legal, equitable, leasehold, or contractual reservation or entitlement, except that, if such multiple holders have
expressly provided for a different distribution of allowances, allowances and proceeds of transactions involving allowances
will be deemed to be held or distributed in accordance with the contract.
Cross-State Air Pollution Rule NOX Annual Trading Program
I certify that I was selected as the designated representative or alternate designated representative, as applicable, by an
agreement binding on the owners and operators of the source and each CSAPR NOX Annual unit at the source.
I certify that I have all the necessary authority to carry out my duties and responsibilities under the CSAPR NOX Annual
Trading Program on behalf of the owners and operators of the source and of each CSAPR NOX Annual unit at the source and
that each such owner and operator shall be fully bound by my representations, actions, inactions, or submissions and by any
order issued to me by the Administrator regarding the source or unit.
Where there are multiple holders of a legal or equitable title to, or a leasehold interest in, a CSAPR NOX Annual unit, or where
a utility or industrial customer purchases power from a CSAPR NOX Annual unit under a life-of-the-unit, firm power contractual
arrangement, I certify that:
I have given a written notice of my selection as the ‘designated representative’ or ‘alternate designated
representative’, as applicable, and of the agreement by which I was selected to each owner and operator of the
source and of each CSAPR NOX Annual unit at the source.
CSAPR NOX Annual allowances and proceeds of transactions involving CSAPR NOX Annual allowances will be
deemed to be held or distributed in proportion to each holder's legal, equitable, leasehold, or contractual reservation
or entitlement, except that, if such multiple holders have expressly provided for a different distribution
of CSAPR NOX Annual allowances by contract, CSAPR NOX Annual allowances and proceeds of transactions
involving CSAPR NOX Annual allowances will be deemed to be held or distributed in accordance with the contract.
EPA Form 7610-1 (Revised 10-2014)
Certificate of Representation
Page 4 of 5
Cross-State Air Pollution Rule NOX Ozone Season Trading Program
I certify that I was selected as the designated representative or alternate designated representative, as applicable, by
an agreement binding on the owners and operators of the source and each CSAPR NOX Ozone Season unit at the
source.
I certify that I have all the necessary authority to carry out my duties and responsibilities under the CSAPR NOX Ozone
Season Trading Program on behalf of the owners and operators of the source and of each CSAPR NOX Ozone Season
unit at the source and that each such owner and operator shall be fully bound by my representations, actions, inactions,
or submissions and by any order issued to me by the Administrator regarding the source or unit.
Where there are multiple holders of a legal or equitable title to, or a leasehold interest in, a CSAPR NOX Ozone Season
unit, or where a utility or industrial customer purchases power from a CSAPR NOX Ozone Season unit under a life-ofthe-unit, firm power contractual arrangement, I certify that:
I have given a written notice of my selection as the ‘designated representative’ or ‘alternate designated
representative’, as applicable, and of the agreement by which I was selected to each owner and operator of the
source and of each CSAPR NOX Ozone Season unit at the source.
CSAPR NOX Ozone Season allowances and proceeds of transactions involving CSAPR NOX Ozone Season
allowances will be deemed to be held or distributed in proportion to each holder's legal, equitable,
leasehold, or contractual reservation or entitlement, except that, if such multiple holders have expressly
provided for a different distribution of CSAPR NOX Ozone Season allowances by contract, CSAPR NOX Ozone
Season allowances and proceeds of transactions involving CSAPR NOX Ozone Season allowances will be
deemed to be held or distributed in accordance with the contract.
Cross-State Air Pollution Rule SO2 Annual Group 1 Trading Program
I certify that I was selected as the designated representative or alternate designated representative, as applicable, by an
agreement binding on the owners and operators of the source and each CSAPR SO2Group 1 unit at the source.
I certify that I have all the necessary authority to carry out my duties and responsibilities under the CSAPR SO2 Group 1
Trading Program on behalf of the owners and operators of the source and of each CSAPR SO2 Group 1 unit at the source
and that each such owner and operator shall be fully bound by my representations, actions, inactions, or submissions and by
any order issued to me by the Administrator regarding the source or unit.
Where there are multiple holders of a legal or equitable title to, or a leasehold interest in, a CSAPR SO2 Group 1 unit, or
where a utility or industrial customer purchases power from a CSAPR SO2 Group 1 unit under a life-of-the-unit, firm power
contractual arrangement, I certify that:
I have given a written notice of my selection as the ‘designated representative’ or ‘alternate designated
representative’, as applicable, and of the agreement by which I was selected to each owner and operator of the
source and of each CSAPR SO2 Group 1 unit at the source.
CSAPR SO2 Group 1 allowances and proceeds of transactions involving CSAPR SO2 Group 1 allowances will be
deemed to be held or distributed in proportion to each holder's legal, equitable, leasehold, or contractual reservation or
entitlement, except that, if such multiple holders have expressly provided for a different distribution
of CSAPR SO2 Group 1 allowances by contract, CSAPR SO2 Group 1 allowances and proceeds of transactions
involving CSAPR SO2 Group 1 allowances will be deemed to be held or distributed in accordance with the contract.
EPA Form 7610-1 (Revised 10-2014)
Certificate of
Representation Page 5 of 5
Cross-State Air Pollution Rule SO2 Annual Group 2 Trading Program
I certify that I was selected as the designated representative or alternate designated representative, as applicable, by
an agreement binding on the owners and operators of the source and each CSAPR SO2 Group 2 unit at the source.
I certify that I have all the necessary authority to carry out my duties and responsibilities under the CSAPR SO2 Group 2
Trading Program on behalf of the owners and operators of the source and of each CASPR SO2 Group 2 unit at the
source and that each such owner and operator shall be fully bound by my representations, actions, inactions, or
submissions and by any order issued to me by the Administrator regarding the source or unit.
Where there are multiple holders of a legal or equitable title to, or a leasehold interest in, a CSAPR SO2 Group 2 unit, or
where a utility or industrial customer purchases power from a CSAPR SO2 Group 2 unit under a life-of-the-unit, firm
power contractual arrangement, I certify that:
I have given a written notice of my selection as the ‘designated representative’ or ‘alternate designated
representative’, as applicable, and of the agreement by which I was selected to each owner and operator of the
source and of each CSAPR SO2 Group 2 unit at the source.
CSAPR SO2 Group 2 allowances and proceeds of transactions involving CSAPR SO2 Group 2 allowances will
be deemed to be held or distributed in proportion to each holder's legal, equitable, leasehold, or contractual
reservation or entitlement, except that, if such multiple holders have expressly provided for a different distribution
of CSAPR SO2 Group 2 allowances by contract, CSAPR SO2 Group 2 allowances and proceeds of
transactions involving SO2 Group 2 allowances will be deemed to be held or distributed in accordance with the
contract.
General
I am authorized to make this submission on behalf of the owners and operators of the source or units for which the
submission is made. I certify under penalty of law that I have personally examined, and am familiar with, the
statements and information submitted in this document and all its attachments. Based on my inquiry of those
individuals with primary responsibility for obtaining the information, I certify that the statements and information are to
the best of my knowledge and belief true, accurate, and complete. I am aware that there are significant penalties for
submitting false statements and information or omitting required statements and information, including the possibility of
fine or imprisonment.
Signature (Designated Representative)
Date
Signature (Alternate Designated Representative)
Date
EPA Form 7610-1 (Revised 6-2016)
Instructions for the Certificate of Representation
NOTE: The Certificate of Representation information can be submitted online through the CAMD
Business System (CBS), which can be accessed at https://camd.epa.gov/cbs/index.cfm. See the
Certificate of Representation tutorial on the CBS homepage for assistance. If you have questions
about CBS, send an email to cbs-support@camdsupport.com.
You must have a user name and password to access CBS. You can obtain a user name and password if: (1)
you are currently listed in the CAMD database as a designated representative or an agent for a designated
representative, AND (2) CAMD has received and processed a hard copy of the Electronic Subscriber
Agreement form at http://www.epa.gov/airmarkets/business/docs/forms/subscriber_agreement.pdf.
Once a person meets the criteria above, he/she may contact one of the following persons to obtain a user
name and password: Karen VanSickle at (202) 343-9220, Kirk Nabors at (202) 343-9171 or Paula Branch
at (202) 343-9168.
Any reference in these instructions to the designated representative means the Acid Rain
designated representative and/or the Cross-State Air Pollution Rule designated representative, as
applicable. Any reference to the alternate designated representative means the alternate Acid
Rain designated representative and/or the alternate Cross-State Air Pollution Rule designated
representative, as applicable. As reflected in this form, the Acid Rain designated representative and the
Cross-State Air Pollution Rule designated representative for a plant must be the same individual, and the
alternate Acid Rain designated representative and the alternate Cross-State Air Pollution Rule
designated representative for a plant must be the same individual.
Please type or print. Submit a separate page 2 for each unit at the plant subject to the Acid Rain Program
(ARP), the MATS program, or a Cross-State Air Pollution Rule Program (CSAPR). Include units for which a
Retired Unit Exemption notice has been submitted. Indicate the page order and total number of pages
(e.g., 1 of 4, 2 of 4, etc.) in the boxes in the upper right hand corner of page 2. A Certificate of
Representation amending an earlier submission supersedes the earlier submission in its entirety
and must therefore always be complete. Submit one Certificate of Representation form with
original signature(s).
NO FIELDS SHOULD BE LEFT BLANK. For assistance, send an email
to cbs-support@camdsupport.com.
STEP 1
(i) A plant code is a 4 or 5 digit number assigned by the Department of Energy’s (DOE) Energy Information
Administration (EIA) to facilities that generate electricity. For older plants, "plant code" is synonymous with
"ORISPL" and "facility" codes. If the plant generates electricity but no plant code has been assigned, or if
there is uncertainty regarding what the plant code is, send an email to the EIA at EIA-860@eia.gov. For plants
that do not produce electricity, use the plant identifier assigned by EPA (beginning with "88"). If the plant does
not produce electricity and has not been assigned a plant identifier, contact Laurel DeSantis at
desantis.laurel@epa.gov.
(ii) Enter the latitude and longitude representing the location of the plant in degree decimal format.
Note that coordinates MUST be submitted in decimal degree format; in this format minutes and seconds
are represented as a decimal fraction of one degree. Therefore, coordinates containing degrees, minutes,
and seconds must first be converted using the formula:
decimal degrees = degrees + (minutes / 60) + (seconds / 3600)
Example:
39 degrees, 15 minutes, 25 seconds = 39 + (15 / 60) + (25 / 3600) = 39.2569 degrees
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STEPS 2 & 3
The designated representative and the alternate designated representative must be individuals (i.e., natural
persons) and cannot be a company. Enter the company name and address of the representative as it should
appear on all correspondence. If an email address is provided, most correspondence will be emailed.
Although not required, EPA strongly encourages owners and operators to designate an alternate
designated representative to act on behalf of the designated representative.
STEP 4
(i) Complete one page for each unit subject to the ARP, MATS, or CSAPR, and indicate the program(s) that
the unit is subject to. Identify each unit at the plant by providing the appropriate unit identification number,
consistent with the identifiers used in previously submitted Certificates of Representation (if applicable) and
with submissions made to DOE and/or EIA. Do not list duct burners. For new units without identification
numbers, owners and operators must assign identifiers consistent with EIA and DOE requirements. Each
submission to EPA that includes the unit identification number(s) (e.g., monitoring plans and quarterly
reports) should reference those unit identification numbers in exactly the same way that they are
referenced on the Certificate of Representation. Do not identify units that are not subject to the above-listed
programs but are part of a common monitoring configuration with a unit that is subject to any of these
programs. To identify units in a common monitoring configuration that are not subject to any of these
programs, call the CAMD Hotline at (202) 343-9620, and leave a message under the “Continuous
Emissions Monitoring” submenu.
(ii) Identify the type of unit using one of the following abbreviations:
Boilers
Boilers
Turbines
AF
Arch-fired boiler
OB
Other boiler
CC
Combined cycle
BFB
Bubbling fluidized bed
boiler
PFB
Pressurized fluidized
bed boiler
CT
Combustion turbine
C
Cyclone boiler
S
Stoker
IGC
CB
Cell burner boiler
T
Tangentially-fired
boiler
Integrated
Gasification
Combined Cycle
CFB
Circulating fluidized bed
boiler
OT
Other turbine
WBF
Wet bottom wall-fired
boiler
Dry bottom wall-fired
boiler
WBT
Wet bottom turbo-fired
boiler
Dry bottom turbo-fired
boiler
WVF
Wet boiler verticallyfired boiler
DB
DTF
DVF
Dry bottom vertically-fired
boiler
Others
ICE
Internal Combustion
engine
KLN
Cement kiln
PRH
Refinery process
heater
If there is uncertainty about how a unit should be characterized, contact Robert Miller at
miller.robertl@epa.gov or (202) 343-9077.
(iii) Indicate the source category description that most accurately describes the purpose for which the unit is
operated by entering one of the following terms. If none of these descriptions applies to your unit, contact
Robert Miller at miller.robertl@epa.gov or (202) 343-9077.
Automotive Stampings
Bulk Industrial Chemical
Cement Manufacturing
Cogeneration
Electric Utility
Industrial Boiler
Industrial Turbine
Institutional
Iron and Steel
Municipal Waste Combustor
2
Petroleum Refinery
Portland Cement Plant
Pulp and Paper Mill
Small Power Producer
Theme Park
(iv) Provide the primary North American Industrial Classification System (NAICS) code that most accurately
describes the business type for which the unit is operated. If unknown, go to http://www.census.gov for
guidance on how to determine the proper NAICS code for the unit.
(v) Enter the date the unit began (or will begin) serving any generator producing electricity for sale, including
test generation. Enter this date and check the "actual" box for any unit that has begun to serve a generator
producing electricity for sale as of the date of submission of this form. (This information should be provided
even if the unit does not currently serve a generator producing electricity for sale.) For any unit that will begin,
but has not begun as of the date of submission of this form, to serve a generator producing electricity for sale,
estimate the future date on which the unit will begin to produce electricity for sale and check the "projected"
box. When the actual date is established, revise the form accordingly by entering the actual date and
checking the "actual" box. Enter "NA" if the unit has not ever served, is not currently serving, and is not
projected to serve, a generator that produces electricity for sale. You are strongly encouraged to use the
CAMD Business System to update information regarding the date a unit begins serving a generator
producing electricity for sale. See the Certificate of Representation tutorial on the CBS homepage for
assistance.
If you have questions regarding this portion of the form, contact Robert Miller at miller.robertl@epa.gov or
(202) 343-9077.
(vi) For a unit subject to the ARP, MATS, or CSAPR, that, as of the date of submission of this form, serves
one or more generators (whether or not the generator produces electricity for sale), enter the generator ID
number(s) and the nameplate capacity (in MWe) of each generator served by the unit. A unit serves a
generator if it produces, or is able to produce, steam, gas, or other heated medium for generating electricity at
that generator. For combined cycle units, report separately the nameplate capacities of the generators
associated with the combustion turbine and the steam turbine. Please ensure that the generator ID numbers
entered are consistent with those reported to the EIA.
The definitions of "nameplate capacity" under the ARP and MATS/CSAPR Programs differ slightly.
Therefore, for a unit subject to the ARP and any MATS/CSAPR Program, the nameplate capacity for the
same generator under the ARP and under the MATS/CSAPR Program may differ in certain limited
circumstances. Specifically, for a unit subject to the ARP, the nameplate capacity of a generator, if listed in
the National Allowance Database ("NADB"), is not affected by physical changes to the generator after initial
installation that result in an increase in the maximum electrical generating output that the generator is
capable of producing. Otherwise, for a unit subject to the ARP or a MATS/CSAPR Program, the nameplate
capacity of a generator is affected by physical changes to the generator after initial installation that result in
an increase in the maximum electrical generating output that the generator is capable of producing. In such
a case, the higher maximum electrical generating output number in MWe should be reported in the
nameplate capacity column. For units subject only to MATS, use the nameplate capacity reported for each
generator on U.S. EIA form EIA-860. If the facility does not report to U.S. EIA, use the nameplate
capacity displayed on the nameplate of the generator served by the unit. Enter "NA" if, as of the date of
submission of this form, the unit does not serve a generator.
See the definition of "nameplate capacity" at 40 CFR 72.2, 97.102, 97.202, 97.302, 97.402, 97.502,
97.602, and 97.702, as applicable.
The NADB is located at the CAMD website at http://
www.epa.gov/airmarkets/trading/allocations.html. If you have questions regarding nameplate capacity,
contact Robert Miller at miller.robertl@epa.gov or (202) 343-9077; if you have questions regarding the NADB,
contact Craig Hillock at hillock.craig@epa.gov or (202) 343-9105.
(vii) Enter the company name of each owner and operator in the "Company Name" field. Indicate whether
the company is the owner, operator, or both. For new units, if the operator of a unit has not yet been chosen,
indicate that the owner is both the owner and operator and submit a revised form when the operator has been
selected within 30 days of the effective date of the selection. EPA must be notified of changes to owners and
operators within 30 days of the effective date of the change. You are strongly encouraged to use the
CAMD Business System to provide updated information on owners and operators. See the Certificate
of Representation tutorial on the CBS homepage for assistance.
(viii) Indicate whether or not the unit is located in Indian Country. For more information see the definition of
“Indian Country” at 40 CFR 97.402, 97.502, 97.602 and 97.702.
3
(ix) When identifying a unit at a plant for the first time, indicate whether or not the unit ever operated at
another location. If the answer is “yes”, the EPA will contact the owners/operator for more information.
STEP 5
Read the appropriate certification statements that apply (if any), sign, and date.
Mail this form to:
For regular/certified mail:
For overnight mail:
U.S. Environmental Protection Agency
1200 Pennsylvania Ave., NW
Mail Code 6204M
Attention: Designated Representative
Washington, DC 20460
U.S. Environmental Protection Agency
1201 Constitution Ave., NW
7th Floor, Room # 7421M
Attention: Designated Representative
Washington, DC 20004
(202) 343-9191
Submit this form prior to making any other submissions under the ARP, MATS or CSAPR
Programs. Submit a revised Certificate of Representation when any information in the existing
Certificate of Representation changes. You are strongly encouraged to use the CAMD Business
System to provide updated information. See the Certificate of Representation tutorial on the
CBS homepage for assistance.
Paperwork Burden Estimate
The public reporting and record keeping burden for this collection of information is estimated to average 15
hours per response annually. Burden means the total time, effort, or financial resources expended by persons
to generate, maintain, retain, or disclose or provide information to or for a Federal agency. This includes the
time needed to review instructions; develop, acquire, install, and utilize technology and systems for the
purposes of collecting, validating, and verifying information, processing and maintaining information, and
disclosing and providing information; adjust the existing ways to comply with any previously applicable
instructions and requirements; train personnel to be able to respond to a collection of information; search data
sources; complete and review the collection of information; and transmit or otherwise disclose the information.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information
unless it displays a currently valid OMB control number.
Send comments on the Agency's need for this information, the accuracy of the provided burden estimates,
and any suggested methods for minimizing respondent burden, including through the use of automated
collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency
(2822T), 1200 Pennsylvania Ave., NW., Washington, D.C. 20460. Include the OMB control number in any
correspondence. Do not send the completed form to this address.
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File Type | application/pdf |
File Title | Certificate of Representation |
Subject | certificate of representation, cert of rep, DR, ADR, designated representative, alternate designated representative |
Author | EPA |
File Modified | 2016-09-13 |
File Created | 2014-10-22 |