BAY AREA AIR QUALITY MANAGEMENT DISTRICT
375 Beale Street, Suite 600, San Francisco, CA 94105 . (415) 749-4990 . fax (415) 749-5030
Website: www.baaqmd.gov
(for District use only)
New Modified Retro
Form C is for all operations which burn fuel except for internal combustion engines (use Form ICE unless it is a gas turbine; for
gas turbines use this form). If the operation also involves evaporation of any organic solvent, complete Form S and attach to this
form. If the operation involves a process which generates any other air pollutants, complete Form G and attach to this form.
Check box if this source has a secondary function as an abatement device for some other source(s); complete lines 1,
2, and 7-13 on Form A (using the source number below for the Abatement Device No.) and attach to this form.
(If unknown, leave blank)
2. Equipment Name & Number, or Description:
Maximum firing rate: Btu/hr
4. Date of modification or initial operation:
(if unknown, leave blank)
5. Primary use (check one):
resource recovery other
electrical generation
process heat; material heated _
space heat waste disposal testing
abatement device cogeneration
6. SIC Number __ __ __
If unknown leave blank
7. Equipment type (check one)
Internal Use Form ICE (Internal Combustion Engine) unless it is a gas turbine
combustion
Incinerator salvage operation pathological waste Temperature F
liquid waste other Residence time Sec
Others boiler dryer
afterburner oven
flare furnace Material dried, baked, or heated:
open burning kiln
other _
8. Overfire air? yes no If yes, what percent %
9. Flue gas recirculation? yes no If yes, what percent %
10. Air preheat? yes no Temperature
F
11. Low NO
x
burners? yes no
Make, Model _
12. Maximum flame temperature F
13. Combustion products: Wet gas flowrate acfm at F
Typical Oxygen Content dry volume % or wet volume % or % excess air
15. Typical % of annual total:
16. With regard to air pollutant flow, what source(s) or abatement device(s) are immediately UPSTREAM?
With regard to air pollutant flow, what source(s) or abatement device(s), and/or emission points are immediately
DOWNSTREAM?
Person completing this form:
(revised 4/12/16)
Data Form C
FUEL COMBUSTION SOURCE