South Coast Air Quality Management District, Form 400-E-7 (2014.07)
Mail To:
SCAQMD
P.O. Box 4944
Diamond Bar, CA 91765-0944
Tel: (909) 396-3385
www.aqmd.gov
South Coast Air Quality Management District
Form 400-E-7
Dry-Cleaning Equipment
This form must be accompanied by a completed Application for a Permit to Construct/Operate - Forms 400-A, Form 400-CEQA, and
Form 400-PS.
Page 1 of 4
CONFIDENTIAL INFORMATION
Under the California Public Records Act, all information in your permit application will be considered a matter of public record and may be disclosed to a third party. If you wish to keep
certain items as confidential, please complete the following steps:
(a) Make a copy of any page containing confidential information blanked out. Label this page “public copy.”
(b) Label the original page “confidential.” Circle all confidential items on the page.
(c) Prepare a written justification for the confidentiality of each confidential item. Append this to the confidential copy.
THIS IS A PUBLIC DOCUMENT
Pursuant to the California Public Records Act, your permit application and any supplemental documentation are public records and may be disclosed to a third party. If you wish to
claim certain limited information as exempt from disclosure because it qualifies as a trade secret, as defined in the District’s Guidelines for Implementing the California Public Records
Act, you must make such claim at the time of submittal
to the District.
Check here if you claim that this form or its attachments contain confidential trade secret information.
* Solvent Consumed = Solvent Purchase + Initial Inventory - Final Inventory - Waste Credit (Please Attach Supporting Documents.)
Section A - Operator Information
Facility Name (Business Name of Operator That Appears On Permit): Valid AQMD Facility ID (Available On Permit Or Invoice Issued By AQMD):
Address where the equipment will be operated:
Section B - Equipment Description
Dry-Cleaning Machine
Manufacturer: Model: Date of Manufacture:
Certification
Is this dry-cleaning machine certified by the California Air Resources Board (CARB)? Yes No
Link to CARB website for certification information http://www.arb.ca.gov/toxics/dryclean.htm
Control
Closed loop with primary and secondary control Closed loop with primary and add-on secondary control
Primary Control Only (Condenser) Other:
Load Capacity Pounds Clothes Cleaned Per Day pounds/day
Section C - Process Description
Type of Solvent
Please attach a copy of the
Material Data Safety Sheet
for all solvents
Hydrocarbon (Petroleum) Solvent Other:
Solvent Usage
Operating Schedule
Gallons Of Solvent Consumed* Per Month:
Density of Solvent: lbs/gal
Operating Parameters
Max. No. of Loads:
per day Min. No. of Loads: per day
Drying Cycle Time:
minutes/load Cool Down Cycle Time: minutes/load
Type Of Building Where Dry
-Cleaner Is Located
Co-Commercial (CC): Share building with commercial occupants, no residents - includes malls
Stand-Alone (SA): No other occupants in building
Distance to nearest receptor:
feet Nearest receptor is: Commercial or Residential
Co-Residential (CR): Share building with residential occupants
Operating Schedule
Normal:
hours/day days/week weeks/yr
Maximum:
hours/day days/week weeks/yr
Section D - Control Equipment Operation
Carbon Absorber As
Secondary Control
No. of loads required before Carbon Absorber is regenerated:
Regeneration Time: minutes
Section E - Authorization/Signature
I hereby certify that all information contained herein and information submitted with this application is true and correct.
Preparer
Info
Signature: Date:
Title: Company Name:
Name:
Phone #: Fax #:
Email:
Contact
Info
Name:
Title: Company Name:
Phone #: Fax #:
Email:
