Environmental Protection Compliance Certification
This compliance certification form is essential for reporting detailed information about boiler and burner installations. Users are required to fill out specific sections pertaining to equipment information and manufacturer certifications. It ensures compliance with the NYC Environmental Protection standards.
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How do I fill this out?
To fill out the compliance certification form, begin by entering the premise information, including the address and borough. Next, provide detailed information about your boiler and burner assembly, including manufacturer and model. Finally, ensure all required certifications and supporting documentation are attached.

How to fill out the Environmental Protection Compliance Certification?
1
Enter premise information including address and borough.
2
Provide accurate details about the boiler and burner assembly.
3
Check that all necessary certifications are attached.
4
Review all entries for completeness and accuracy.
5
Submit the completed form as per the provided instructions.
Who needs the Environmental Protection Compliance Certification?
1
Facility Managers may require this form to ensure compliant installations.
2
Boiler Technicians need it for reporting and certification purposes.
3
Environmental Compliance Officers might use the form to monitor adherence to regulations.
4
Engineers and Contractors require the documentation for project completions.
5
Government Agencies need it for regulatory evaluations and audits.
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What are the instructions for submitting this form?
To submit the completed form, email it to the Bureau of Environmental Compliance at dep-compliance@nyc.gov. You may also fax it to (718) 595-3856. For physical submissions, send the documents to 59-17 Junction Boulevard, 9th Floor, Flushing, NY 11373. Please ensure all attachments are included for a successful submission.
What are the important dates for this form in 2024 and 2025?
Important dates for filing this form may vary annually. Typically, submissions are due by December 31st for the year prior. Ensure compliance by checking local guidelines for any updated deadlines.

What is the purpose of this form?
The purpose of this form is to ensure compliance with NYC's environmental regulations concerning the installation and operation of boilers and burners. It gathers vital information regarding performance tests, certifications, and equipment specifications. Accurate submissions contribute to public safety and environmental protection efforts.

Tell me about this form and its components and fields line-by-line.

- 1. Premise Information: Includes details about the installation location such as address, floor, and borough.
- 2. Boiler Information: Gathers technical specifications about the boiler, including manufacturer, model, and heating capacity.
- 3. Burner Information: Collects data about the burner, its fuel type, and performance ratings.
- 4. Control Equipment Information: Requests specifics regarding control systems used in the installation.
- 5. Certification: Confirms that all equipment complies with required standards and certifications.
What happens if I fail to submit this form?
Failure to submit this form can result in penalties from regulatory bodies. The absence of proper documentation may lead to fines and operational restrictions. It's crucial to ensure timely and complete submissions to avoid complications.
- Regulatory Compliance: Non-submission can lead to violations of environmental regulations.
- Financial Penalties: Improper filings may incur fines that could have been avoided.
- Operational Delays: Failure to provide necessary documentation can halt operational processes.
How do I know when to use this form?

- 1. Installation Approval: Required for new boiler and burner installations.
- 2. Modification Reporting: Necessary when equipment undergoes modifications or upgrades.
- 3. Renewal of Certifications: Used for renewing annual compliance certifications with the Department.
Frequently Asked Questions
How do I edit this PDF?
To edit the PDF, simply open it in PrintFriendly and select the sections you wish to modify.
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Yes, after editing, you can easily share it via email or social media.
What should I do if I need to sign the document?
You can add your signature directly in the PDF editor before finalizing the document.
Is there a way to save my changes?
Yes, download the edited PDF to save your changes locally.
What information is required to fill out this form?
You'll need to provide information about the premise, boiler, and burner assembly.
Do I need to attach manufacturer datasheets?
Yes, datasheets must be attached for all non-accepted equipment.
Who can help if I have questions while filling this out?
You can contact the Bureau of Environmental Compliance for assistance.
What happens if I submit incomplete information?
Incomplete submissions may lead to delays or rejections in certification.
Is there a way to preview my changes before submitting?
Absolutely, you can review the document in PrintFriendly before finalizing.
How do I contact for more information?
You can reach the Records Control at (718) 595-3855 for further inquiries.
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