Example: Test Plan For Boiler Sources 
 

Proposed test date(s): 

(Test plan postmark or e-mail date submittal date triggers 30 day notification period) 
 

PART I.  GENERAL INFORMATION 
 

1. Name and street address of emission facility:

   If company cannot receive mail at the street address, a mailing address should also be indicated. 
 

   Name, Title, Telephone, E-mail address and Facsimile number of contact person at emission facility:  

   This one person will receive correspondence & participate in the pretest meeting.  They should be knowledgeable about the emission unit being tested, and be able to relay operating and documentation requirements to appropriate company staff.  List address if different from above. 
 

2. Permit File Number:

   AQ File Number (if known):  
 

3. Reason the emission unit(s) is (are) to be tested: 

   (Performance test to demonstrate compliance with:  Permit No, Stipulation Agreement dated xx/xx/xx, Administrative Penalty Order dated xx/xx/xx, Notice of Noncompliance Dated xx/xx/xx, Notice of Indeterminate Compliance dated xx/xx/xx, or refer to the Test Plan cover sheets for other types of test classifications.  Please be as descriptive as possible to ensure your test plan is reviewed accurately.)  Note that, in all cases, retests following noncompliance or indeterminate compliance tests should be indicated as Retest # (1, 2, etc.) where applicable.&