Bureau of Air Quality - Initial Notice for Excess Emissions and Malfunctions

FROM: * Example of completed form (PDF)
COMPANY: *
TOWN: * Abbot Acton Adamstown Twp Addison Albany Twp Albion Alder Brook Twp Alder Stream Twp Alexander Alfred Allagash Alna Alton Amherst Amity Andover Andover North Surplus Andover West Surplus Anson Appleton Appleton Twp Argyle Twp Arrowsic Arundel Ashland Athens Atkinson Attean Twp Auburn Augusta Aurora Avon Bailey Island Baileyville (near Calais) Bald Mountain Twp T2 R3 Bald Mountain Twp T4 R3 Baldwin Bancroft Bangor Bar Harbor Bar Mills Baring Plantation Barnard Twp Bass Harbor Batchelders Grant Bath Bayville Beals Beattie Twp Beaver Cove Beddington Belfast Belgrade Belgrade Lakes Belmont Benedicta Twp Benton Bernard Berwick Bethel Biddeford Biddeford Pool Big Moose Twp Big Six Twp Big Ten Twp Big Twenty Twp Big W Twp Bigelow Twp Bingham Birch Harbor Blaine Blake Gore Blanchard Twp Blue Hill Blue Hill Falls Boothbay Boothbay Harbor Bowdoin Bowdoin College Grant East Bowdoin College Grant West Bowdoinham Bowerbank Bowmantown Twp Bowtown Twp Bradford Bradley Bradstreet Twp Brassua Twp Bremen Brewer Bridgewater Bridgton Brighton Plt Bristol Brooklin Brooks Brooksville Brookton Twp Brownfield Brownville Brunswick Bryant Pond Buckfield Bucks Harbor Bucksport Burlington Burnham Bustins Island Buxton Byron C Surplus Calais Cambridge Camden Canaan Canton Cape Elizabeth Cape Neddick Cape Porpoise Caratunk Cardville Caribou Carmel Carrabassett Valley Carroll Plt Carrying Place Town Twp Carrying Place Twp Carthage Cary Plt Casco Castine Castle Hill Caswell Center Lovell Centerville Chain of Ponds Twp Chamberlain Chapman Charleston Charlotte Chase Stream Twp Chebeague Island Chelsea Cherryfield Chester Chesterville Chesuncook Twp China Clayton Lake Cliff Island Clifton Clinton Coburn Gore Codyville Plt Columbia Columbia Falls Comstock Twp Concord Twp Connor Twp Cooper Coopers Mills Coplin Plt Corea Corinna Corinth Cornish Cornville Costigan Cove Point Twp Cox Patent Cranberry Isles Crawford Criehaven Twp Crystal Cumberland Cumberland Center Cushing Cutler Cyr Plt Dallas Plt Damariscotta Danforth Danville Davis Twp Days Academy Grant Dayton Dead River Twp Deblois Dedham Deer Isle Denmark Dennistown Plt Dennysville Detroit Devereaux Twp Dexter Dixfield Dixmont Dole Brook Twp Dover-Foxcroft Dresden Drew Plt Dryden Dudley Twp Durham Dyer Brook Dyer Twp E Twp Eagle Lake Eagle Lake Twp East Andover East Baldwin East Boothbay East Corinth East Dixfield East Eddington East Holden East Lebanon East Livermore East Machias East Middlesex Canal Grant East Millinocket East Moxie Twp East Orland East Parsonfield East Peru East Poland East Sebago East Stoneham East Waterboro East Waterford East Wilton East Winthrop Eastbrook Easton Eastport Eddington Edgecomb Edinburg Edmunds Twp Eliot Elliottsville Twp Ellsworth Elm Stream Twp Embden Emery Mills Enfield Etna Eustis Exeter Fairfield Falmouth Farmingdale Farmington Fayette Five Islands Flagstaff Twp Forest City Twp Forest Twp Forkstown Twp Forsyth Twp Fort Fairfield Fort Kent Fowler Twp Frankfort Franklin Freedom Freeman Twp Freeport Frenchboro Frenchtown Twp Frenchville Friendship Frye Frye Island Fryeburg Gardiner Garfield Plt Garland Georgetown Gilead Glen Cove Glenburn Glenwood Plt Gorham Gorham Gore Gouldsboro Grafton Twp Grand Falls Plt Grand Isle Grand Lake Stream Plt Gray Great Pond Greenbush Greene Greenfield Greenville Greenville Junction Greenwood Grindstone Twp Guilford Hallowell Hamlin Hammond Hammond Twp Hampden Hancock Hanover Harborside (Brooksville) Harfords Point Twp Harmony Harpswell Harrington Harrison Hartford Hartland Haynesville Hebron Hermon Hersey Herseytown Twp Hibberts Gore Highland Plt Hiram Hobbstown Twp Hodgdon Holden Holeb Twp Hollis Hope Hopkins Academy Grant Houlton Howland Hudson Indian Island Indian Stream Twp Indian Twp Res Industry Island Falls Islands of Moosehead Lake Isle au Haut Islesboro Jackman Jackson Jay Jefferson Jim Pond Twp Johnson Mountain Twp Jonesboro Jonesport Katahdin Iron Works Twp Kenduskeag Kennebunk Kennebunkport Kents Hill Kezar Falls Kibby Twp Kineo Twp King & Bartlett Twp Kingfield Kingman Twp Kingsbury Plt Kittery Kittery Point Knox Kossuth Twp Lagrange Lake View Plt Lakeville Lambert Lake Twp Lamoine Lang Twp Lebanon Lee Leeds Levant Lewiston Lexington Twp Liberty Lille Lily Bay Twp Limerick Limestone Limington Lincoln Lincoln Center Lincoln Plt Lincolnville Lincolnville Center Linneus Lisbon Lisbon Center Lisbon Falls Litchfield Little Deer Isle Little W Twp Littleton Livermore Livermore Falls Lobster Twp Locke Mills Long A Twp Long Island Long Pond Twp Lovell Lowell Lowelltown Twp Lower Cupsuptic Twp Lower Enchanted Twp Lubec Ludlow Lyman Lynchtown Twp Machias Machiasport Macwahoc Plt Madawaska Madison Madrid Twp Magalloway Plt Manchester Mapleton Mariaville Marion Twp Mars Hill Marshfield Masardis Mason Twp Massachusetts Gore Matinicus Matinicus Island Plt Mattamiscontis Twp Mattawamkeag Maxfield Mayfield Twp Mechanic Falls Meddybemps Medford Medomak Medway Mercer Merrill Merrill Merrill Strip Mexico Milbridge Milford Millinocket Milo Milton Twp Minot Misery Gore Misery Twp Molunkus Twp Monhegan Plt Monmouth Monroe Monson Monticello Montville Moody (Ogunquit) Moose River Moosehead Junction Twp Moro Plt Morrill Moscow Mount Abram Twp Mount Chase Mount Desert Mount Katahdin Twp Mount Vernon Moxie Gore Mussel Ridge Shoals Twp Naples Nashville Plt Nesourdnahunk Twp New Canada New Gloucester New Harbor New Limerick New Portland New Sharon New Sweden New Vineyard Newagen Newburgh Newcastle Newfield Newport Newry No 14 Twp No 21 Twp Nobleboro Norridgewock North Amity North Anson North Berwick North Bridgton North Brooklin North Edgecomb North Fryeburg North Haven North Monmouth North New Portland North Shapleigh North Turner North Vassalboro North Waterboro North Whitefield North Yarmouth North Yarmouth Academy Grant Northeast Carry Twp Northfield Northport Norway Oakfield Oakland Ocean Park Ogunquit Olamon Old Orchard Beach Old Town Oqiton Twp Oquossoc Orient Orland Orneville Twp Orono Orrington Orrs Island Osborn Otis Otisfield Owls Head Oxbow Plt Oxbow Twp Oxford Palermo Palmyra Paris Parkertown Twp Parkman Parlin Pond Twp Parmachenee Twp Parsonsfield Passadumkeag Patten Pejepscot Pemaquid Pembroke Penobscot Penobscot Indian Nation Perham Perkins Twp Perkins Twp (Swan Island) Perry Peru Phillips Phippsburg Pierce Pond Twp Pittsfield Pittston Pittston Academy Grant Pleasant Point Pleasant Ridge Plt Plymouth Plymouth Twp Poland Poland Spring Port Clyde Portage Lake Porter Portland Pownal Prentiss Twp T4 R4 NBKP Prentiss Twp T7 R3 NBPP Presque Isle Princeton Prospect Prospect Harbor Pukakon Twp Rainbow Twp Randolph Rangeley Rangeley Plt Raymond Readfield Redington Twp Reed Plt Richardsontown Twp Richmond Riley Twp Ripley Robbinston Rockland Rockport Rockwood Rockwood Strip T1 R1 NBKP Rockwood Strip T2 R1 NBKP Rome Roque Bluffs Round Pond Roxbury Rumford Rumford Center Rumford Point Russell Pond Twp Sabattus Saco Saint Agatha Saint Albans Saint Croix Twp Saint David Saint Francis Saint George Saint John Plt Saint John Twp Sakom Twp Salem Twp Sandbar Tract Sandwich Academy Grant Sandy Bay Twp Sandy River Plt Sanford Sangerville Sapling Twp Sargentville Scarborough Seal Cove Searsmont Searsport Sebago Sebasco Sebec Seboeis Plt Seboomook Twp Sedgwick Seven Ponds Twp Shapleigh Shawtown Twp Sherman Sherman Mills Shirley Sidney Silver Ridge Twp Sinclair Skinner Twp Skowhegan Small Point Smithfield Smyrna Soldier Pond Soldiertown Twp T2 R3 NBKP Soldiertown Twp T2 R7 WELS Solon Somerville Soper Mountain Twp Sorrento South Berwick South Bristol South Casco South China South Freeport South Gardiner South Gouldsboro South Harpswell South Hiram South Paris South Portland South Thomaston South Waterford Southport Southwest Harbor Spencer Bay Twp Springfield Springvale Spruce Head Squapan Twp Squaretown Twp Squirrel Island Stacyville Standish Starks Steep Falls Stetson Stetsontown Twp Steuben Stockholm Stockton Springs Stoneham Stonington Stow Stratton Strong Sullivan Summit Twp Sumner Sunset Surry Swans Island Swanville Sweden T1 R10 WELS T1 R11 WELS T1 R12 WELS T1 R13 WELS T1 R5 WELS T1 R6 WELS T1 R8 WELS T1 R9 WELS T10 R10 WELS T10 R11 WELS T10 R12 WELS T10 R13 WELS T10 R14 WELS T10 R15 WELS T10 R16 WELS T10 R3 WELS T10 R6 WELS T10 R7 WELS T10 R8 WELS T10 R9 WELS T10 SD T11 R10 WELS T11 R11 WELS T11 R12 WELS T11 R13 WELS T11 R14 WELS T11 R15 WELS T11 R16 WELS T11 R17 WELS T11 R3 NBPP T11 R4 WELS T11 R7 WELS T11 R8 WELS T11 R9 WELS T12 R10 WELS T12 R11 WELS T12 R12 WELS T12 R13 WELS T12 R14 WELS T12 R15 WELS T12 R16 WELS T12 R17 WELS T12 R7 WELS T12 R8 WELS T12 R9 WELS T13 R10 WELS T13 R11 WELS T13 R12 WELS T13 R13 WELS T13 R14 WELS T13 R15 WELS T13 R16 WELS T13 R5 WELS T13 R7 WELS T13 R8 WELS T13 R9 WELS T14 R10 WELS T14 R11 WELS T14 R12 WELS T14 R13 WELS T14 R14 WELS T14 R15 WELS T14 R16 WELS T14 R5 WELS T14 R6 WELS T14 R7 WELS T14 R8 WELS T14 R9 WELS T15 R10 WELS T15 R11 WELS T15 R12 WELS T15 R13 WELS T15 R14 WELS T15 R15 WELS T15 R5 WELS T15 R6 WELS T15 R8 WELS T15 R9 WELS T16 MD T16 R12 WELS T16 R13 WELS T16 R14 WELS T16 R4 WELS T16 R5 WELS T16 R6 WELS T16 R8 WELS T16 R9 WELS T17 R12 WELS T17 R13 WELS T17 R14 WELS T17 R3 WELS T17 R4 WELS T17 R5 WELS T18 ED BPP T18 MD BPP T18 R10 WELS T18 R11 WELS T18 R12 WELS T18 R13 WELS T19 ED BPP T19 MD BPP T19 R11 WELS T19 R12 WELS T2 R10 WELS T2 R12 WELS T2 R13 WELS T2 R4 WELS T2 R8 NWP T2 R8 WELS T2 R9 NWP T2 R9 WELS T22 MD T24 MD BPP T25 MD BPP T26 ED BPP T27 ED BPP T28 MD T3 Indian Purchase T3 Indian Purchase T3 ND T3 R1 NBPP T3 R10 WELS T3 R11 WELS T3 R12 WELS T3 R13 WELS T3 R3 WELS T3 R4 BKP WKR T3 R4 WELS T3 R5 BKP WKR T3 R7 WELS T3 R8 WELS T3 R9 NWP T30 MD BPP T31 MD BPP T32 MD T34 MD T35 MD T36 MD BPP T37 MD BPP T39 MD T4 Indian Purchase T4 Indian Purchase T4 ND T4 R10 WELS T4 R11 WELS T4 R12 WELS T4 R13 WELS T4 R14 WELS T4 R15 WELS T4 R17 WELS T4 R3 WELS T4 R5 NBKP T4 R7 WELS T4 R8 WELS T4 R9 NWP T4 R9 WELS T40 MD T41 MD T42 MD BPP T43 MD BPP T5 ND BPP T5 R1 NBPP T5 R11 WELS T5 R12 WELS T5 R14 WELS T5 R15 WELS T5 R17 WELS T5 R18 WELS T5 R19 WELS T5 R20 WELS T5 R6 BKP WKR T5 R7 BKP WKR T5 R7 WELS T5 R8 WELS T5 R9 NWP T5 R9 WELS T6 ND BPP T6 R1 NBPP T6 R10 WELS T6 R11 WELS T6 R12 WELS T6 R13 WELS T6 R14 WELS T6 R15 WELS T6 R17 WELS T6 R18 WELS T6 R6 WELS T6 R7 WELS T6 R8 WELS T7 R10 WELS T7 R11 WELS T7 R12 WELS T7 R13 WELS T7 R14 WELS T7 R15 WELS T7 R16 WELS T7 R17 WELS T7 R18 WELS T7 R19 WELS T7 R5 WELS T7 R6 WELS T7 R7 WELS T7 R8 WELS T7 R9 NWP T7 R9 WELS T7 SD T8 R10 WELS T8 R11 WELS T8 R14 WELS T8 R15 WELS T8 R16 WELS T8 R17 WELS T8 R18 WELS T8 R19 WELS T8 R3 NBPP T8 R3 WELS T8 R4 NBPP T8 R5 WELS T8 R6 WELS T8 R7 WELS T8 R8 WELS T8 R9 WELS T8 SD T9 R10 WELS T9 R11 WELS T9 R12 WELS T9 R13 WELS T9 R14 WELS T9 R15 WELS T9 R16 WELS T9 R17 WELS T9 R18 WELS T9 R3 WELS T9 R4 WELS T9 R5 WELS T9 R7 WELS T9 R8 WELS T9 R9 WELS T9 SD TA R10 WELS TA R11 WELS TA R2 WELS TA R7 WELS Talmadge Taunton & Raynham Academy Grant TB R10 WELS TB R11 WELS TC R2 WELS TD R2 WELS Temple Tenants Harbor The Forks Plt Thomaston Thorndike Thorndike Twp Tim Pond Twp Tomhegan Twp Topsfield Topsham Township 6 North of Weld Township C Township D Township E Tremont Trenton Trescott Twp Trevett Trout Brook Twp Troy Turner Turner Center TX R14 WELS Union Unity Unity Twp Upper Cupsuptic Twp Upper Enchanted Twp Upper Molunkus Twp Upton Van Buren Vanceboro Vassalboro Veazie Veazie Gore Verona Vienna Vinalhaven Wade Waite Waldo Waldoboro Wales Wallagrass Walpole Waltham Warren Washburn Washington Washington Twp Waterboro Waterford Waterville Wayne Webbertown Twp Webster Plt Weeks Mills (near New Sharon) Weeks Mills (near S. China) Weld Wellington Wells Wesley West Baldwin West Bath West Bethel West Boothbay Harbor West Bowdoin West Buxton West Forks Plt West Gardiner West Kennebunk West Middlesex Canal Grant West Minot West Newfield West Paris West Peru West Poland West Rockport West Southport West Sullivan West Sumner West Tremont Westbrook Westfield Westmanland Weston Westport Whitefield Whiting Whitneyville Williamsburg Twp Willimantic Wilton Windham Windsor Winn Winslow Winter Harbor Winterport Winterville Plt Winthrop Wiscasset Woodland (near Calais) Woodland (near Caribou) Woodstock Woodville Woolwich Wyman Twp Wytopitlock Yarmouth York
License #: A - * - license type 70 71 - license sequence A B C D E F G H I J K L M N O P Q R S T U V W X Y Z - license activity 1 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z / license activity 2 if needed A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
FAX: PHONE: *
SOURCE OF EMISSION: *
TYPE OF EMISSION: * Cl2/ClO Opacity NOx SO2 TRS VOC CO OTHER IF OTHER, GIVE DETAILS:
DATE*	TIME BEGAN*>	TIME ENDED*	DURATION*	MAGNITUDE*	LICENSE COND./LIMIT /STANDARD*
1) emission date 1 mm/dd/yyyy	emission time began 1	emission time ended 1	emission duration 1	emission magnitude 1	license condition, limit, standard exceeded 1
2) emission date 2 mm/dd/yyyy	emission time began 1	emission time ended 1	emission duration 1	emission magnitude 1	license condition, limit, standard exceeded 1
3) emission date 1 mm/dd/yyyy	emission time began 1	emission time ended 1	emission duration 1	emission magnitude 1	license condition, limit, standard exceeded 1
4) emission date 1 mm/dd/yyyy	emission time began 1	emission time ended 1	emission duration 1	emission magnitude 1	license condition, limit, standard exceeded 1
CAUSE OF EMISSION: * Start-up Shut-down Process Problem Control Equipment Problem Cleaning / Sootblow Other Known Cause Unknown Cause
EXPLANATION: *
ACTIONS TO LIMIT EMISSION: *
ACTIONS TO LIMIT RECURRENCE: *
EXEMPTION REQUESTED: * YES NO TO BE DETERMINED
RESPONSIBLE OFFICIAL: *
EMAIL ADDRESS:

NOTE:  Details of this event must be documented and included in the quarterly emission report which is submitted to the Maine Department of Environmental Protection, Bureau of Air Quality.