Fillable Emergency Variance Application Form Instructions (Bay Area Air Quality Management District)

Fill Online, Printable, Fillable, Blank Emergency Variance Application Form Instructions (Bay Area Air Quality Management District) Form

Use Fill to complete blank online BAY AREA AIR QUALITY MANAGEMENT DISTRICT (CA) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Emergency Variance Application Form Instructions (Bay Area Air Quality Management District)

On average this form takes 14 minutes to complete

The Emergency Variance Application Form Instructions (Bay Area Air Quality Management District) form is 7 pages long and contains:

  • 1 signature
  • 14 check-boxes
  • 47 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Bay Area Air Quality Management District

BROWSE BAY AREA AIR QUALITY MANAGEMENT DISTRICT (CA) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Emergency Variance Application Form Instructions
Requests for emergency variances (EV) from Bay Area Air Quality Management District
(BAAQMD) air pollution regulations should be submitted to the Hearing Board of the BAAQMD
using the attached form.
The Hearing Board is an independent quasi-judicial body created by California State law with
the sole authority to grant variances from air quality regulations.
Proper completion of the EV Application form will help the Hearing Board fully consider your
request.
EMERGENCY VARIANCE SPECIAL CONSIDERATIONS
An Emergency Variance (EV) is a variance that can be granted for good cause without a public
hearing of the Hearing Board only for very special circumstances leading to non-compliance.
The following stringent conditions must be satisfied before such a variance is granted. Non-
compliance must be the result of an unforeseen emergency, such as a sudden equipment
breakdown, power failure, accidental fire, or natural disaster. In the case of an equipment
breakdown, the Applicant must clearly and convincingly demonstrate that the breakdown was
beyond their reasonable control and that issues of poor maintenance or negligence are clearly
not involved. An Emergency Variance cannot be granted for more than 30 days.
FILING STEPS:
1. Make a request via telephone by contacting the Clerk of the Hearing Board at
(415) 749-5073.
2. When a telephone request is received, the Clerk’s Office Staff will File the EV at the
time and date of the initial call and insert these on the EV application form before
emailing the form to the Applicant. The Applicant must complete the form and return
it to the Clerk’s Office. If the EV phone call request is received at or before 3 p.m.,
the Applicant must return the completed EV form to the Clerk’s Office by the end of
that same business day (i.e. by 5 p.m.), but no later than 8:30 a.m., on the next
business day. If the EV phone call is received after 3 p.m., then the Applicant may
return the completed form no later than Noon on the next business day.
3. If you need more space to complete the application form, supplemental sheets may
be used. Please attach the additional pages and properly identify the numbered
section of the application form that they support.
4. Pursuant to Regulation 3-301 and Health & Safety Code Sec. 42364(a), the filing fee
is due within four (4) working days from the date of submission of the EV application,
whether or not the EV is granted by the Hearing Board. Checks should be made
payable to BAAQMD and recommended to be sent via overnight delivery service
1
APPLICATION FOR EMERGENCY VARIANCE
TO THE HEARING BOARD
OF THE
BAY AREA AIR QUALITY MANAGEMENT DISTRICT
STATE OF CALIFORNIA
(415) 749-5073
(All Documents Filed with The Clerk’s Office Become Public Record)
(NOTE: If additional space is needed to provide information on this Application, supplemental sheets
may be used.)
TO BE COMPLETED BY CLERK:
Date and Time Application Called In: DOCKET NO.:
Name of Clerk Receiving Application: Phone # of Clerk:
APPLICANT INFORMATION:
Name of Applicant: Plant # or G #:
Address of Facility:
CONTACTS:
Person Providing Information
Alternate Contact (Optional)
Name
Title
Company
Phone #
email
2
1. Briefly describe the type of operation or facility:
How many employees do you have?
What is your Gross annual income?
List parent company and/or subsidiaries of the Applicant:
2. Describe the equipment/activity for which a Variance is being sought (type of
equipment/activity, purpose, why is it essential to your business?):
Source #(s):
If Applicable: Total # of Nozzles Tagged Out-of-Order: out of:
3. Is there a regular maintenance and/or inspection schedule for this equipment?
Yes No
If Yes, how often?
What was the date of the last maintenance and/or inspection?
Are maintenance records available?
Was there any indication of problems?
4. District Regulation(s) and/or Permit Condition(s) from which variance relief is
sought:
(If Opacity will exceed Ringelmann 2 during the variance period, include California
Health and Safety Code Section 41701 in Applicant’s request for Variance.)
3
5. Describe, in detail, the failure or malfunction (include how and when it was
discovered, who discovered it and what is the nature of the failure):
Did the failure/malfunction create a public nuisance? Yes No
Has Applicant received any complaints from the public regarding the operation of the
subject equipment or activity within the last six months? Yes No
6. Has the District issued any Notice(s) of Violation (NOVs) to the Applicant
concerning this failure/malfunction? Yes No
If Yes, provide NOV #s:
(If available, please attach a copy of each NOV.)
7. Describe the cause(s) of the failure or malfunction. Include the name and title of
the person who determined the cause of the failure/malfunction:
8. Carefully explain why the circumstances leading to the need for this Emergency
Variance were beyond the Applicant’s reasonable control and why they satisfy
the “EMERGENCY VARIANCE SPECIAL CONSIDERATIONS” listed on Page # 1:
4
9. Estimated Total Excess Emissions:
Pollutant
Net Emissions After Mitigation (lbs/day or Opacity %)
Provide Supporting calculations.
10. Do the additional emissions from the failure or malfunction contain any Toxic Air
Contaminants (TAC) [pursuant to Health and Safety Code Section 39655] or
odorous substances? Yes No If Yes, list the TAC’s:
Provide supporting calculations:
11. What actions has Applicant taken to correct the failure or malfunction?
12. What immediate actions did Applicant take to mitigate excess emissions?
13. Briefly explain Applicant’s plan for returning to compliance:
5
14. Please write in the variance period Applicant is requesting:
VARIANCE PERIOD REQUESTED
Start Time and Date:
End Time and Date:
15. Explain how Applicant plans to reduce (mitigate) excess emissions during the
variance period to the maximum extent feasible, or why reductions are not
feasible (mitigation may include reductions at other sources):
16. If requested to do so, will the Applicant monitor or quantify emissions during the
variance period? Yes No
17. Has Applicant considered curtailing or modifying operations of the source in lieu
of obtaining a variance? Yes No
Briefly explain why Applicant cannot curtail, terminate or modify operations in
lieu of obtaining a variance:
6
VERIFICATION
I, the undersigned, do hereby declare under penalty of perjury, under the laws of the State of
California, that I have read the foregoing document and that I know its contents are true.
Dated at_______________________________, on_______________________________
Signature_________________________________ Title____________________________
TO BE COMPLETED BY CLERK:
Date and Time Application for Emergency Variance delivered to Enforcement Division:
Date:____________________________ Time:___________________
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Emergency Variance Application Form Instructions (Bay Area Air Quality Management District)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 27 January 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document