Questions in the Environmental Justice Summary online submission form for Air Quality Regulation 3

1. Company name.
2. Facility name. (If the facility does not have a name, enter the company name).
3. Facility address.
4. Census block group(s) in which the facility is located. (This information is found in the facility’s Environmental Justice Report).
5. Which type of air permit will you be applying for?
   1. Initial Title V permit
   2. Title V permit renewal or modification
   3. General permit
   4. Construction permit
   5. Land development - GP03
6. What specific outcomes or changes will result from the requested permitting action?
   1. An increase in emissions
   2. A decrease in emissions
   3. No change in emissions
   4. A “net decrease” in emissions
7. Has this facility previously received an official permit or exemption letter from the Air Pollution Control Division (APCD)?
   1. If “yes,” what is the AIRS ID of this facility? (The AIRS ID number will be listed on the permit or exemption letter. It is seven or ten digits, usually written "XXX-XXXX" or "XXX-XXXX-XXX").
   2. If “yes,” what is the permit number or exemption number?

1. Company representative name.
2. Company representative phone number.
3. Company representative email address.

The Environmental Justice Report Tool and how-to instructions are available on the Environmental justice in air permitting web page. Please run an Environmental Justice Report for your facility to answer the questions below.

1. Based on the Environmental Justice Report generated, is this facility located in a Disproportionately Impacted Community? (Yes/No)
2. If yes, what type of Disproportionately Impacted Community is the facility located in based on the Environmental Justice Report?
   1. Cumulatively Impacted (CI) Community only
   2. Socioeconomically Vulnerable (SV) Community only
   3. Both a Cumulatively Impacted (CI) Community and a Socioeconomically Vulnerable (SV) Community

Note: As of July 15, 2024, emissions calculations are no longer required.

1. Is this facility an Affected Construction Source? (More information on Affected Construction Sources can be found in the online form).
2. Will this facility emit any Affected Pollutants? Select all that apply.
   1. Affected Pollutants include volatile organic compounds (VOCs), nitrogen oxides (NOX), particulate matter ≤ 2.5 microns in diameter (PM_2.5), and BTEX (benzene, toluene, ethylbenzene, and xylene).
3. Provide a brief description of the proposed permit application. Please provide this information even if your facility is not located in a Disproportionately Impacted Community.
4. Based on the results of the facility’s Environmental Justice Report results and/or engagement with the Disproportionately Impacted Community, describe any: 
   1. Mitigation measures and/or changes to the proposed emission sources (such as enhanced monitoring, recordkeeping, and/or reporting); 
   2. Emission reduction and control strategies; and/or,
   3. Changes made to the originally planned source equipment or operations.

For facilities located in Disproportionately Impacted Communities, the Air Pollution Control Division encourages thoughtful and culturally sensitive enhanced public outreach by the facility to keep communities informed and engaged with the latest information. This includes any engagement with members of the Disproportionately Impacted Community who reside within one mile of the proposed Affected Construction Source or frequent an Occupied Area within one mile of the proposed Affected Construction Source, unless the Occupied Area is under the control of the proposed Affected Construction Source’s owner/operator.

Explore community engagement, outreach, and public participation best practices on CDPHE’s website.

1. Did the owner/operator of the facility conduct or plan to conduct enhanced community outreach to the impacted community prior to submitting the main permit application?
   1. Yes
   2. No
   3. Planned, in progress, or to be determined

Note: If the option “Planned, in progress, or to be determined” is selected, describe any measures that are planned, in progress, or to be determined.

Note: If “Yes” is selected, the following optional response fields will appear. Please fill these out according to any outreach or engagement conducted for the facility or project.

Part 1: Know the audience, community, and purpose

1. Did you contact residents within at least one-mile radius of the facility to notify them about the proposed permit or project and how they can provide feedback?
2. Did you contact and/or coordinate with any of the following types of organizations or individuals to understand local audiences and the most effective ways to reach them? (Select all that apply).
   1. CDPHE
   2. Local public health agencies
   3. Local governments
   4. Community groups
   5. Community leaders
   6. Industry associations
   7. Public libraries
   8. Faith-based and secular institutions
   9. Hospitals and clinics
   10. Schools and universities
   11. Social and activity clubs
   12. Civic organizations
   13. Businesses
   14. Nonprofits/Nongovernmental organizations
   15. Community-based or neighborhood organizations
   16. None of the above
   17. Other - Please explain:
3. Provide any additional information about the audience, community, and purpose of the community engagement. Also provide the name of any organizations contacted.

Part 2: Host public meetings at various times and days

A best practice is to hold meetings at various times of day and week, such as a weekday evening and weekend morning.

1. Meeting date.
2. Meeting time. 
3. Meeting type: (Select all that apply).
   1. Virtual
   2. In-person
   3. Hybrid
4. Meeting location(s) (venue name, street address, and/or coordinates).
5. Number of registered participants.
6. Number of public participants and community members in attendance.

Note: There will be an “Add Meeting” button available to add more information if more than one meeting was held.

Part 3: Host public meeting(s) in locations that are safe and accessible

1. If the facility hosted in-person or hybrid meetings, did you choose locations that were: (Select all that apply).
   1. Within the affected disproportionately impacted community
   2. In a central, easily accessible location close to the disproportionately impacted community
   3. Accessible by public transportation
   4. Accessible by bicycle or walking
   5. Equipped with sufficient and accessible vehicle parking
   6. None of the above
   7. Other - Please explain:
2. Location accessibility- the location was accessible by: (Select all that apply).
   1. Public transportation
   2. Bicycle or walking
   3. Sufficient and accessible vehicle parking 
   4. None of the above
   5. Other - Please explain:
3. Did you publish meeting and presentation materials on a publicly accessible website?
   1. If yes, please provide the link to the website.
4. Did you use a facilitator to keep the meeting on track?
5. Provide any additional information about accessible meeting considerations:

Part 4: Provide at least 30 days' notice ahead of public meetings

1. Did you provide at least 30 days' notice ahead of public meetings?
2. Did you provide at least one reminder in advance of the meeting?

Part 5: Actively promote outreach and public participation opportunities

1. Communication tactics used for promoting meetings: (Select all that apply).
   1. Fliers
   2. Fact sheet
   3. Email
   4. Text notification
   5. Website
   6. Social media
   7. Door-to-door outreach
   8. Public notice
   9. TV ad
   10. Radio ad
   11. None of the above
   12. Other - Please explain:
2. Were any of the communication tactics provided in multiple languages?
3. If you selected “yes” to the previous question, please list the languages used in communication tactics and why they were chosen: 
4. Did you attend community events or collaborate with trusted partners and organizations to share updates, messages, and public meeting information?
5. Provide any additional information about meeting outreach, communication, and promotion activities:

Part 6: Ensure language justice, cultural competency, and accessibility in outreach materials

1. Were meetings made available in multiple languages (interpretation services provided for non-English speakers)? 
2. Were meeting materials translated into multiple languages?
3. If interpreters were used, please note the vendor who provided interpretation:
4. If translation was used, please note the vendor who provided the translation: 
5. Were digital accessibility best practices used for web content, digital fliers, social media posts, or other digital communications?
6. Provide any additional information about accessibility considerations: 

Part 7: Provide various and accessible methods for receiving public feedback

1. Which of the following opportunities and platforms were provided for the public to provide feedback? (Select all that apply).
   1. Email
   2. Online comment forms
   3. Surveys
   4. Phone calls
   5. Verbal comment at a community meeting
   6. Audio recordings 
   7. Video recordings
   8. None of the above
   9. Other - Please explain:
2. Number of public feedback comments received in writing:  
3. Number of public feedback comments received verbally: 
4. How did you review public feedback received and use it to inform the proposed project?
5. Provide any additional information about public comments received and considered:

Part 8: Reduce barriers to participation via participation stipends, childcare services, and more

1. Provided for public meeting attendees: (Select all that apply). 
   1. Childcare stipends
   2. On-site childcare
   3. Participation stipends
   4. Food
   5. None of the above
   6. Other - Please explain:
2. Included in the public meeting: (Select all that apply). 
   1. Meeting purpose
   2. Meeting agenda 
   3. Instructions on how to submit comments
   4. Explanation of how questions will be addressed
   5. Code of conduct/ground rules
   6. None of the above
   7. Other - Please explain: 
3. Provide a short description of the activities conducted, methods used, and any additional information about reducing barriers for the community.

To submit a complete Environmental Justice Summary to the division, attach the following documents to this online form:

1. Facility’s Environmental Justice Report generated by the Environmental Justice Report Tool for Air Quality Regulation 3.
2. If this facility is located in a Disproportionately Impacted Community, a description and/or documentation of any community outreach activities conducted or planned as mentioned in Section 5.
3. Any additional supporting documentation.