South Coast Air Quality Management District, Form 400-E-8 (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-8
Ethylene Oxide Sterilizer
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 2
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 (for equipment which will be moved to various location in AQMD’s jurisdiction, please list the initial location site):
Fixed Location Various Locations
Section B - Equipment Description
Equipment
Manufacturer: Model: Serial No.:
Internal Dimensions of
Sterilizer Chamber
Width:
ft. in. Length: ft. in. Height: ft. in.
Sterilizer Heater
Information
a. Electric:
KW c. Steam
Operating Temperature:
˚F
b. Gas:
BTU/hr d. Other (specify):
Sterilizer Exhaust Blower
Information
Capacity:
ACFM
Internal Dimensions of
Aeration Chamber
Width:
ft. in. Length: ft. in. Height: ft. in.
Aeration Heater Information
a. Electric:
KW c. Steam
Operating Temperature:
˚F
b. Gas:
BTU/hr d. Other (specify):
Aeration Exhaust Blower
Information
Capacity:
ACFM
Section C - Operation Information
Sterilant Gas Information
a. Composition
Ethylene Oxide (ETO): % by weight:
b. Maximum Temperature:
˚F
c. Pressure:
psi
Sterilizer Vented
Information
Is Sterilizer vented to an external Air Pollution Control (APC) equipment?
a. No
b. Yes; Please Indicate Type of Control
Catalytic Afterburner
Condensation/Reclamation
Acid-water Scrubber
Other
A separate permit is required
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South Coast Air Quality Management District, Form 400-E-8 (2014.07)
South Coast Air Quality Management District
Form 400-E-8
Ethylene Oxide Sterilizer
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.
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.
Page 2 of 2
Section C - Operation Information (cont.)
Process Information
Weight of ETO:
lbs/load Average Usage: loads/day
Maximum Usage:
loads/day
Operating Schedule
Normal:
hours/day days/week weeks/yr
Maximum:
hours/day days/week weeks/yr
Section D - 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:
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.
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