South Coast Air Quality Management District, Form 400-E-20 (2015.08)
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-20
Plasma Arc/Laser Cutter
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.
Chec
k 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 locations in AQMD’s jurisdiction, please list the initial location site):
Fixed Location Various Locations
Section B - Equipment Description
Equipment
1. Manufacturer: Model: Serial No.:
2. Cutting Method Plasma Laser Other _________________________
3. a) Dry cutting Semi-Wet Cutting Wet Cutting
b) Handheld Table
4. Equipment Dimensions W __________ inches x L __________ inches x H __________ inches
5. Power Rating ___________________ KW KVA
For plasma arc cutting: Power Supply Manufacturer __________________________ Model ____________________________
6. Maximum Thickness of Metal Cut __________________________ inches
7. Maximum Cutting Speed at Thickness above __________________________
inches/min
8. Maximum Cutting Width (KERF) of plasma or laser beam _
_________________________ inches millimeters
9. Type and Amount of Material Being Cut (Select all that apply.)
Stainless Steel __________ ft / day __________ lbs / day
Mild Steel __________ ft / day __________ lbs / day
Other _______________________________ __________ ft / day __________ lbs / day
At
tach Material Safety Data Sheets (MSDS) for each metal cut. Also attach manufacturer’s equipment specifications.
Air Pollution Control*
(APC)
Is this equipment vented to APC equipment? No Yes If Yes, a separate permit is required.
If Yes, describe APC: ____________________________________________________________________
If already permitted: Permit No.: __________________ OR Application No.: __________________
*If you are cutting metals that contain chrome and/or nickel, a control device with HEPA filters may be required.
Section C - Operating Information
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:
__________ ft
3
/ day
__________ ft
3
/ day
__________ ft
3
/ day
click to sign
signature
click to edit
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