Fillable Form 400-PS.: External Combustion Food Broiler/Fryer Section A (SCAQMD)

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Form 400-PS.: External Combustion Food Broiler/Fryer Section A (SCAQMD)

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South Coast Air Quality Management District, Form 400-E-9e (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-9e
External Combustion
Food Broiler/Fryer
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.:
Type
Under-fired or Food Charbroiler Conveyorized or Chain-driven Charbroiler
Deep Fat Fryer Other (specify):
Note: Equipment used in eating establishments does not require a permit.
Fuel
Natural Gas Charcoal
Wood Electric
LPG Other (specify):
Burner
No. of Burners: Max. Rating per Burner: Total Rating: Charcoal or Wood: Electric:
(Natural Gas or LPG) BTU/hr BTU/hr lbs/hr kW
Conveyorized Broiler
No. of Conveyor Motor(s):
Is Conveyor Vented? Yes No
Motor Rating(s):
HP
Air Pollution Control
External If external, a separate permit is required.
Integral Please describe Control.
Describe Integral Air Pollution Control:
Section C - Operation Information
Fuel Consumption
Maximum Rated Load:
gal/hr or cu.ft./hr
Average Load:
gal/hr or cu.ft./hr
Food Product
(Check All That Apply)
Beefsteak Potato Chips Hamburger
Noodles Fish Other (specify):
Chicken Tortilla Chips
Production
Total Pounds of Meat, Fish, and Chicken Cooked Per Day: Max.:
Avg.:
Average Weight of Item Cooked:
lbs/item
Maximum Production Rate For Each Product:
lbs/hour lbs/day
South Coast Air Quality Management District, Form 400-E-9e (2014.07)
South Coast Air Quality Management District
Form 400-E-9e
External Combustion
Food Broiler/Fryer
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 2 of 2
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 C - Process Description (cont.)
Deep Fat Fryer
Type of cooking oil used:
Cooking oil boiling point:
˚F Cooking oil smoke point: ˚F
Maximum temperature of cooking oil maintained in fryer:
˚F
Amount of Material Processed:
Average:
lbs/hr lbs/day Maximum: lbs/hr lbs/day
Percent Moisture in Material Processed:
%
Stack or Vent Data
Stack Height:
ft. in. Stack Diameter: ft. in.
Exhaust Flow Rate:
CFM Exhaust Temperature: ˚F
Exhaust Pressure:
inches of water column
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:
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Form 400-PS.: External Combustion Food BroilerFryer Section A (SCAQMD)

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Completed 12 August 2020

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