Reporting period dates: From   to    
Company:
Emission Limitation      
Address:
Monitor Manufacturer and Model No.    
Date of Latest CMS Certification or Audit    
Process Unit(s) Description:
Total source operating time in reporting period1.    
Emission data summary1
1. Duration of excess emissions in reporting period due to:
a. Startup/shutdown
b. Control equipment problems
c. Process problems
d. Other known causes
e. Unknown causes
2. Total duration of excess emission
3. [Total duration of excess emissions] × (100)/[Total source operating time] (%2):
CMS performance summary1
1. CMS downtime in reporting period due to:
a. Monitor equipment malfunctions
b. Non-monitor equipment malfunctions
c. Quality assurance calibration
d. Other known causes
e. Unknown causes
2. Total CMS downtime
3. [Total CMS downtime] × (100)/[Total source operating time] (%2):
1For opacity, record all times in minutes. For gases, record all times in hours.
2For the reporting period: If the total duration of excess emissions is 1% or greater of the total operating time or the total CMS downtime is 5% or greater of the total operating time, both the summary report form and the excess emission report described in sub. (3) shall be submitted.