South Coast Air Quality Management District, Form 400-E-9a (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-9a
External Combustion: Boiler/Heater
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 1
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.
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
Boiler/Heater
Manufacturer:
Model: Serial No.:
Max. Heat Input Rating (Higher Heating Value - HHV): Boiler Type: Water-Tube
BTU per hour Fire-Tube
Burner
Manufacturer:
Model:
Number of burners: Rating of each burner (HHV): Type: Low NOx (please attach manufacturer’s specifications)
Other:
Blower
HP:
Natural Gas LPG Refinery Gas
* Digester Gas* Landfill Gas*
Other
*: Fuel Oil (Specify Grade):
If Digester or Landfill Gas, List Higher Heating Value:
Natural Gas LPG Refinery Gas
* Digester Gas* Landfill Gas*
Other
*: Fuel Oil (Specify Grade):
If Digester or Landfill Gas, List Higher Heating Value:
* If Digester Gas, Landfill Gas, Refinery Gas, and/or Other are checked, attach fuel analysis indicating higher heating value and sulfur content.
Type Of Controls
(Check All
That Apply)
Low NOx Burner Flue Gas Recirculation Oxygen Trim CO Catalyst
1
Selective Catalytic Reduction (SCR)
1
Thermal DeNOx (Selective Non-Catalytic Reduction, SNCR)
1
Other (specify):
1
A separate permit is required, please see Form 400-E-GI for instructions.
Fuel Usage
Average Load
% OR Average Firing Rate (HHV): MMBTU/hr
Fuel Type
Primary Fuel:
Secondary or
Stand-by Fuel:
Section C - Process Description
Operating Parameters
Turn Down Ratio:
Percent Excess Air: %
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:
