LDAR Site Questionnaire

Revision 4 9/15/01 Page 1 WWW.LDAR.COM Fugitive Emissions LDAR - SITE QUESTIONNAIRE Date: Prepared By: Site: Type: Refinery Chemical Plant City/State: Name Job Function Phone e-mail Environmental Manager LDAR Program Admin. LDAR Data Admin LDAR Monitoring Tech Mark who is responsible for the following activities: * Data download/upload for field monitoring ** Compliance reports Existing LDAR Program Description (insert “X” for multiple choice questions) Existing LDAR Program: In-House Outside Contractor Hybrid of both Analyzers Used: OVA 108 TVA 1000A TVA 1000B Other_______ Data Collection Method: Pen & Paper Data Logger: Expected Changes to LDAR Program or Other Comments: Repairs: 1st Attempts By: Monitoring Tech Maintenance Contractor Effective Repairs By: Monitoring Tech Maintenance Contractor Work Requests to Repair Leakers are Submitted to: Current Method of Submittal: Regulatory Requirements Regulations: Mark all regulations this Site is required to comply with for fugitive emissions. Fill in regulations not listed. Part 63, Subpart H: HON Part 63 Ref MACT Subpart CC Part 60, Subpart QQQ Part 60, Subpart V V Part 264/265, Subpart BB Part 60, Subpart KKK Refinery MACT NSPS “V V” Part 264/265, Subpart CC Pesticide MACT “MMM” Refinery MACT HON Part 61, Subpart FF P.E.T. MACT Part 61, Subpart V (or J) Part 61, Subpart Y Texas 28M Louisiana 2121 NJ VOC Standards Texas 28MD Louisiana 2122 NJ Petroleum Refinery Texas 28MID Louisiana 3351 NJ Nat Gas/Gasoline Texas Modified 28MID SCAQMD Rule 1173 PA Refinery Texas Modified 28RCT SCAQMD Rule 1176 PA SOC Texas Formaldahyde Ventura County Rule 74.7 Ohio Texas VHP W V Ref 21 Texas Reg 5 Indiana IDEM Texas HR VOC Illinois Site Specific Rules or Permit Requirements: Mass Emissions Calculations: Mark methods used. EPA Correlation Equations SOCMI Factors Leak/No Leak Unit Specific Factors Stratification Comments: Revision 4 9/15/01 Page 2 WWW.LDAR.COM Existing LDAR Software Description Existing Software: Data Administrator: # of individual Components that require monitoring: Expected Changes to Total: Installation Type: Stand Alone PC Local Area Network Wide Area (multi-plant) Network If installed on Network, How Many Users? Existing Database Contains Historical Monitoring Data back to - Date: Existing LDAR Software Performs Mass Emissions Calcs: Yes No Site has Duplicate Tag Numbers: Yes No Any other forms of Component ID besides LDAR Tag Number? Existing Software Likes/DisLikes: Other Software Used at the Plant: EMIS: P&ID: Maintenance Management: Safety Equipment Inspection: New LDAR Software Requirements Database Capacity (Components): Installation Type: Stand Alone PC Local Area Network Wide Area (multi-plant) Network If installed on Network, How Many Users? Preferred Database: Foxpro Access SQL Server Oracle Data Collection: LeakTracker MARS HVM 680 TVA DataManager LeakDAS FIT - PPC Pen & Paper LeakDAS FIT™ for Palm Other: Data Conversion: Asset Data (existing inventory info) Historical to Jan of this year Historical for previous years: Special Requirements: Optional Functionality: Emissions Calculations Route Sequencing Custom Report Designer Software Training: # of Days: On-Site In Louisville, KY Desired Implementation Date: Expected Order Date: