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EXAMPLE Tune-up Record and Compliance Certification
National Emission Standards for Hazardous Air Pollutants for Area Sources:
Industrial, Commercial, and Institutional Boilers
40 CFR Part 63 Subpart JJJJJJ
This form shows examples of what on site records should be maintained to document your tune-up.
Your regulated boiler may require additional detail, depending on your boiler design. This list is not all-
inclusive, because it is not modeled after a particular system, but instead gives only general
information that is applicable to most systems.
What is the purpose of this form?
You may use this form to meet the requirements for completing and documenting a tune-up
under the National Emission Standards for Hazardous Air Pollutants for Area Sources:
Industrial, Commercial, and Institutional Boilers. However, you may also record the information
in another form or format.
SECTION I: INSTRUCTIONS
Check the applicable box below:
R(My boiler is subject to a tune-up requirement.
If you did not check the box above, do not use this example record. See
' hftp://www.epa.gov/ttn/atw/boiler/boilerpq.html for additional implementation tools.
When is this form due (§63.11225(b))?
Existing Sources: For each tune-up conducted, Sections I-V of this form are records that you
should keep to demonstrate compliance with this rule. The first tune-up should be
completed by March 21, 2014. Subsequent biennial or 5-year tune-ups, as
applicable, should be completed no later than 25 months or 61 months,
respectively, after the previous tune-up.
The first Compliance Certification Report (Section VI of this form) must be
prepared by March 1, 2015. Later certifications must be prepared by March 1 of
the year following the calendar year during which a biennial or 5-year tune-up is
completed.
New Sources: For each tune-up conducted, Sections I-V of this form are records that you
should keep to demonstrate compliance with this rule. The first biennial or 5-year
tune-up, as applicable, must be no later than 25 months or 61 months,
respectively, after the initial startup of the boiler. Subsequent biennial or 5-year
tune-ups, as applicable, should be completed no later than 25 months or 61
months, respectively, after the previous tune-up.
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The first Compliance Certification Report (Section VI of this form) must be
prepared by March 1 of the year following the calendar year during which the first
biennial or 5-year tune-up is completed. Later certifications must be prepared by
March 1 of the year following the calendar year during which a biennial or 5-year
tune-up is completed.
Where do I send this form (§63.11225(b))?
This certification does not need to be submitted, but it must be maintained on site as a record and
may be requested by the delegated authority.
SECTION II: RECORD OF GENERAL BOILER INFORMATION
Date: 3- .3i7-) H
Reporting Period:
Boiler Operator: lj l ko r) 5 ® Gre-e-lrl
Boiler Emission Unit IDa: �S- Iq '90r 12✓ &Or`Jer (00&578
Tune-Up Conducted By: (_ �, �d r` )e- � — L
Please Print
Use the boiler emission unit ID consistent with the ID provided in the Initial Notification Report.
5 1 P a g e

The first Compliance Certification Report (Section VI of this form) must be
prepared by March 1 of the year following the calendar year during which the first
biennial or 5-year tune-up is completed. Later certifications must be prepared by
March 1 of the year following the calendar year during which a biennial or 5-year
tune-up is completed.
Where do i send this form (§63.11225(b))?
This certification does not need to be submitted, but it must be maintained on site as a record and
may be requested by the delegated authority.
SECTION II: RECORD OF GENERAL BOILER INFORMATION
Date: 3 —3 O -I L1
Reporting Period:
Boiler Operator: A-1 #01 0 0 _ )
Boiler Emission Unit IDa: . S ' Jr l�o 2 v # Z 136, le,i#
Tune-Up Conducted By: C 4 C 13oi le✓ — /1A l &n*,5fzW
Please Print
a Use the boiler emission unit ID consistent with the ID provided in the Initial Notification Report.
5 Page

SECTION III: RECORD OF TUNE-UP PROCEDURES (§63.11225(c)(2) and (§63.11223(b)(6))
Check the applicable box when the procedure is completed. If the procedure does not apply to
you, indicate `not applicable' or `NA'in the comments column.
0 Ca 5 9
Requirement Description Inspector Comments/
Corrective Actions Taken
Rr Inspect the burner Clean or replace any components of the
burner, as necessary A) a-
[,i Inspect the flame Adjust the burner as necessary to optimize
pattern the flame pattern. The adjustment should
be consistent with the manufacturer's N I pr
specifications, if available.
[✓]� Inspect air-to-fuel ratio Ensure system is calibrated and
control systemb functioning properly, if such a system is
installed on the boiler ri
[� Optimize emissions of Optimize emissions consistent with the
carbon monoxide (CO) manufacturer's specifications, if available,
and with any nitrogen oxide requirement to ny
which the boiler is subject.
Measure CO and 02 Parameter Before After
levels in exhaust, before Basis
and after tune-up° wet or d N
CO (ppmv) rn 3 P P w►
02 (% by volume) r) 3 •'1 y.
b You may delay the inspection until the next scheduled unit shutdown,but you must inspect each burner at least once every 36
months if subject to biennial tune-ups,and at least once every 72 months if subject to 5-year tune-ups.
`Measurements may be made on either a dry or wet basis,as long as it is the same basis before and after the tune-up adjustments
are made. CO concentration measurements must be made in units of parts per million by volume(ppmv).Oxygen(02)
concentration measurements must be made as percent by volume.
61Page

SECTION III: RECORD OF TUNE-UP PROCEDURES (§63.11225(c)(2) and (§63.11223(b)(6))
Check the applicable box when the procedure is completed. If the procedure does not apply to
you, indicate `not applicable' or `NA'in the comments column.
6-S-S 1.3ol ley- (0 s�
Requirement Description Inspector Comments/
Corrective Actions Taken
Inspect the burner" Clean or replace any components of the
burner, as necessary /J
Inspect the flame Adjust the burner as necessary to optimize
pattern the flame pattern. The adjustment should
be consistent with the manufacturer's N '
specifications, if available.
Inspect air-to-fuel ratio Ensure system is calibrated and
c ptrol system" functioning properly, if such a system is N' Pr
a installed on the boiler
Optimize emissions of Optimize emissions consistent with the
carbon monoxide (CO) manufacturer's specifications, if available,
and with any nitrogen oxide requirement to N `
which the boiler is subject.
Measure CO and 02 Parameter Before After
levels in exhaust, before Basis
and after tune-up° wet or d AJ (�
CO (ppmv) 39 vvml
02 (% by volume)
b You may delay the inspection until the next scheduled unit shutdown, but you must inspect each burner at least once every 36
months if subject to biennial tune-ups,and at least once every 72 months if subject to 5-year tune-ups.
` Measurements may be made on either a dry or wet basis,as long as it is the same basis before and after the tune-up adjustments
are made.CO concentration measurements must be made in units of parts per million by volume(ppmv).Oxygen (02)
concentration measurements must be made as percent by volume.
6 1 P a g e

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)4) 597-0003 Cilcrlotle
tiJ�l [phone] Lexington
ti�' ,'?14r,y (ia •'w '.,,,�„ :.'` r' h�.;;F€ [phone] Greensboro
`J Sales 8 Service,Inc.
[phone] Duncan
Inc. ------- --
'.:US T O � F. _ C-B REP RESEN @ ATiVE Date -- ----- ;
Contract t' E
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Unit # r
Model#
Boiler #
VISUALLY CHECK AND TES'! START BURNER AND C:aECK CHECK FUEL OIL CONTROLLER
Comb.Air pressure switch ❑ Pilot operat. PACKING,GAGES [�
Stack Thermometer ❑ Main flame ignition ❑ CHECK AND ADJUST V-BE,LTS,
Pressure/temp. control ❑ INSPECT FOR AIR LEAKAGE PULLEYS ❑
Gas POC ❑ Front door
Oil pressure switch ❑ Rear door ❑ I Reading Actual
Gas pressure switch ❑ Vent stub
Potentiometer press. switch ❑ CHECK OIL LEAKS OLC
Low fire start switch ❑ Oil pump ❑ MPC
Oil POC ❑ Oil strainers ❑ LGPS
CHECK OPERATION Oil valves 171 HGPS
Modulator ❑ All linkages ❑ LOPS ��
REMOVE:AND CL E-5�1 E3�tt IW DOWN WATER COP t!MN CF-'EC`� r, _
. `, 'idi'.J a Vi'+ r 3,
5 .dis�r'�
Oil assembly ❑ L.W.C.O. ❑ Blower
Fuel oil strainer ❑ Aux.LAY.C.O. ❑ Air Pump
Gas pilot assembly ❑ Feed pump control © Fuel Pump
SAFETY CHECKS COMBUSTION CHECK Fuel
Shut pilot gas supply. Start burner. Cam Position 1 2 3 I r c I fi 2
Flame detector operation
OK NO %CO2
%02
i
Wrth burner on, shut off fuel valve %CO
manually. Control closes electrically
———4—
operated fuel valve in sec. Stack Temp.
Safety lockout in sec,
Gas Pressure
With boiler in lot^r fire, Oil 4umer Pres .
check refractory.
Type of combustion analysis equipment used
Fuel Rate: High Fire Low Fire
I ,
Comments
i
Arts Used QL Part 4
Representative Signature I
1
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i4arre:
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€ r V I
i 'rustomP-r Signature !
i I Jame:
I _ I DO�xC r';'RITE:aERE
-': 5 f-�evievi by Date ;
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IY II I .-omrnents — — — --

ii) 597-0003 i narloii=
/\ 3) 303-3366 �exinyton
' z 7n C:-} •� y �1 (336) 275-163-1 Graensboro
J i7 I [phone] Duncan
Sales&:Service,Inc.
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� G"wJ3T01L,.E2, � C-R REPRESENIITA T IVE � Date ------- 3
Contract# --
Unit# -
Model #
Boiler #
VISt_ALL°.CHECK AMID TEST START BURNER AND CHECK CHECK FUEL OIL CONTROLLER
erat. C9
comb..Air pressure switch 0 Pilot op PACKING,GAGES
�
E Q) t Main flame ignition � e � 9 ,
i -Stack Thermometer �--. � CHECK�ilt��' ADJUST�l-BE�TS,
Pressure/temp.control D i INSPECT FOR AIR LEAKAGE PULLEYS �
Gas P OC D Front door
9 Oil pressure switch 0 i Rear door 4aa'i tg ACEtsal
Gas pressure switch Q I Vent stub HLC
Potentiometer press. switch 0 %HECK OIL LEAkKS O C `
Low fire start switch Q Oil pump NIPC
Oil POC 0 Oil strainers ❑ LGPS
CHECK OPERATION Oil valves HGPS
Modulator ❑ All linkages C! LOPS
PE`:')0l`E z1%fdD Ct_EE.1? DRAW DO1RN WATER COLUMN, CHECK ��OT�OP 11�?t_TS nn'?S ry0�
Oil assembly L.W.C.O. Blower
Fuel oil strainer 12- aux.I_AMC.0. Air Pump
i
Gas pilot assembly Feed pump control Fuel Pump
SAFETY CHECKS COMBUSTION CHECK Fuel
Shut pilot gas supply. Start burner. Cara Position 1 2 3 4 5 6 T I S 10 11 -12
Flame detector operation %CO2
OK NO
°/02
With burner on, shut off fuel valve °i CO
manually. Control closes elec4rically I
operated fuel valve in sec. Stad�Temp.
Safety lockout in sec. —
! Gas Pressure
i
With boiler in low fire, Oil°urr,ar P.
check refractory.
Type of combustion analysis equipment used i
Fuel Rate: High Fire Low Fire
Comments li
I
f Paris Used City. 'art 4
Representative Signature
Name:
� I
i
Customer Signature
t
i
lj-- --- y�'-B ;Qsvis%-a by Date
3,onments _ _ _

SECTION IV: RECORD OF MANUFACTURER SPECIFICATIONS (§63.11225(c)(2))
S .2Q Afl-7,r,Vk VV\ ^*_
If your boiler has manufacturer specifications for adjusting the flame patterns or optimizing total emissions of carbon monoxide,
maintain a copy of these specifications in your records.
SECTION V: RECORD OF FUEL TYPE AND AMOUNT USED OVER THE 12 MONTHS PRIOR TO THE TUNE-UP,BUT ONLY IF THE
BOILER WAS PHYSICALLY AND LEGALLY CAPABLE OF USING MORE THAN ONE TYPE OF FUEL DURING THAT PERIOD
(§63.11223(b)(6)(iii)) Skp- Gk
Amount of fuel used or delivered for the 12 months preceding the tune-upe
Fuel Delivery Date
Typed Or Period of Units Consumption
measure f
[Add rows to the table for additional fuels,as necessary.]
If you have more than one boiler that must conduct a tune-up, please repeat Sections II, III, IV, and V for each boiler.
Otherwise, proceed to Section VI below.
d Report all fuels used in each of the units subject to the standard(e.g.,bituminous coal,#6 fuel oil,#2 fuel oil,natural gas,bark,lumber,etc.).Seethe definition of fuel
type in§63.11237.
EPA recognizes that not all facilities have fuel metering capabilities.Records of fuel delivery-instead of fuel consumption-will also meet the rule requirements. Affected
sources have discretion on the periods of fuel records maintained on-site.The records may be annual,monthly,or periodic,depending on fuel delivery frequencies.
f e.g.,Gallons,tons,standard cubic feet(scf),etc.
7 � P< <e

S e c,4i U►n IZ.e coy-cj O F n/l aIn 4v_Y,e_ S Pe-c
Chapter 6 Adjustment Procedures
1 The appearance or color of the gas flame is not an indication
of its efficiency,because an efficient gas flame will vary from
TO FOLLOWER OF transparent blue to translucent yellow.
GAS MODULATING CAM
Most flue gas analyzers in use today measure the content,by
y; percentage of oxygen(02)and carbon monoxide(CO)either
by percent or parts per million(ppm). Carbon dioxide(CO2)
is not normally measured with todays flue gas analyzers,but
may be displayed via.a calculation.
HIGH
FIRE The 02 levels through the entire firing range of the burner,
t low fire to high fire should be tested.The burner manufactures
recommendations on turndown should also be followed and
BUTTERFLY GAS the turndown ran a of the burner should not be exceeded.
VALVE ROD g
It's important to understand what the readings shown on an
LOW instrument refer to-when setting combustion in a boiler. To
OVERRIDE BUTTERFLY GAS ? FIRE assist with this understanding Figure 6-9 shows the
SPRINGS VALVE ARM relationship between 02 levels (excess air) and the products
of combustion for a typical flue gas analysis(natural gas).
O One of the products of combustion is CO2(Carbon Dioxide).
O O O ' O This is shown in percentage.
Another product of combustion is CO(carbon monoxide)and
is shown in both percentage and parts per million(ppm).The
maximum CO level standardly allowed is less than 400 ppm.
' However,this may change subject to local regulations.
LOW FIRE HIGH FIRE
STOP SCREW STOP SCREW
Figure:6-10 Butterfly Gas Valve
1
S� t 0
Q. GAS FUEL COMBUSTIONM
ADJUSTMENT 'L y' r
After operating for a sufficient period of time to assure aUS17
warm boiler, adjustments should be made to obtain efficient
combustion. MO G ,
Burner efficiency is measured by the amount or percentage of
02 present in the flue gas. 02 readings determine the total
amount or excess air in the combustion process, above the - • . „
t
point of Stoichiometric combustion or perfect combustion. f
Stoichiometric combustion is a term used to describe a V .Y
condition when there is the exact amount, molecule for
molecule,of air for the fuel attempting to be burned.This can sAi 1 ••
be accomplished under laboratory conditions, however it's a • • -
not practical to attempt to meet this condition in a boiler. ' t
Stoichiometric combustion however, is the reference point
used when setting fuel/air ratios in a boiler.
There must always be excess air in the combustion. to
account for changes in boiler room temperature and HIGH FIRE
atmospheric conditions, and to ensure the combustion is on
the proper side of the combustion curve(See Figure 6-9). LOW FIRE
Proper setting of the air/fuel ratios at all rates of firing must Figure:6-11 Fuel Modulating Camp/'
be established by the use of a combustion or flue gas analyzer.
6-12 750-94

S� - CM CG✓G� v rype- �" ou-n+ we d Ov2
1 -Z, onw AD --tom 4uAA c L-P
Lewiston Processing Plant ES-4, ES-5
Rolling 12 Tons of Sulfur Dioxide & NOX
Natural Gas / #6 Fuel
GALLONS % Natural TONS OF TONS of
GAS
MONTH YEAR COMBUSTED SULFUR Mcf S02 Nox
February 2013 0 2.1 13093 0.00 0.65
March 2013 0 2.1 13231 0.00 0.66
April 2013 0 2.1 12271 0.00 0.61
May 2013 0 2.1 13223 0.00 0.66
June 2013 0 2.1 12810 0.00 0.64
July 2013 0 2.1 12595 0.00 0.63
August 2013 0 2.1 11035 0.00 0.55
September 2013 0 2.1 5838 0.00 0.29
October 2013 0 2.1 8242 0.00 0.41
November 2013 0 2.1 14141 0.00 0.71
December 2013 0 2.1 14041 0.00 0.70
January 2014 0 2.1 14801 0.00 0.74
February 2014 0 2.1 12999 0.00 0.65
March 2014 0 2.1 14104 0.00 0.71
April 2014 0 2.1 11733 0.00 0.59
May 2014 0 2.1 12996 0.00 0.65
June 2014 0 2.1 12695 0.00 0.63
July 2014 0 2.1 12770 0.00 0.64
August 2014 0 2.1 12347 0.00 0.62
September 2014 0 2.1 11981 0.00 0.60
October 2014 0 2.1 12564 0.00 0.63
November 2014 0 2.1 11668 0.00 0.58
December 2014 0 2.1 13282 0.00 0.66
1st. Rolling 12 0 145,321 0 7
2nd.Rolling 12 0 145,227 0 7
3rd.Rolling 12 0 146,100 0 7
4th. Rolling 12 0 145,562 0 7
5th. Rolling 12 0 145,335 0 7
6th. Rolling 12 0 145,220 0 7
7th. Rolling 12 0 145,395 0 7
8th. Rolling 12 0 146,707 0 7
9th. Rolling 12 0 152,850 0 8
10th.Rolling 12 0 157,172 0 8
11th. Rolling 12 0 154,699 0 8
12th.Rolling 12 0 153,940 0 1 8

SECTION VI: FACILITY INFORMATION AND CERTIFICATION (§63.11225(b)(1) and (2))9
Facility Name: pe rdLk 2 1�jt)d6
Facility Street Address: 3539. CJI-Aiavv,ws 2cQ
City State Zip
certify that my facility has complied with the requirements in §63.11223 to conduct a biennial or
5-year tune-up, as applicable, of each boiler.
By my signature, I am certifying that my facility has complied with all relevant standards and other
requirements of 40 CFR part 63 subpart JJJJJJ and certifying the truth, accuracy and completeness
of this document.
/�/ yy�
Name of Responsible Official (please print) Title
Phone Number Email Address
Signature of Respoptsi@e Official Date
g This certification does not need to be submitted,but it must be maintained on site as a record and may be requested by the
delegated authority.
8 1 P a g e