Fillable Form 400-PS.: Printing Equipment Section B - Equipment (SCAQMD)

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Form 400-PS.: Printing Equipment Section B - Equipment (SCAQMD)

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South Coast Air Quality Management District, Form 400-E-15 (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-15
Printing 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 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 locations in AQMD’s jurisdiction, please list the initial location site):
Fixed Location Various Locations
Section B - Equipment Description
Press Type
Manufacturer: Model: Serial No.:
Flexographic Lithographic Gravure
Screen Letter Press Inkjet
Other (specify):
Number of Color Stations:
Paper Feed Method
Sheet Web
Maximum Sheet/Web Width:
in. Maximum Speed: (specify unit)
Substrate Type
Porous Non-Porous Textile Coated Uncoated
Section C - Operation Information
Product Description
Paper Packaging Reports Calendars Labels
Plastic Packaging Inserts Brochures Publication
Newspaper Magazines Other (specify)
Mode of Ink Drying
Air Dry Infrared Lamps or Electric Elements
: kW Ultraviolet : kW
Natural Gas Fired , Rating:
Btu/hr
No. of burners:
BTU Rating of Each Burner: Btu/hr Total Btu Rating: Btu/hr
Is Burner Low NOx? No Yes
If Yes, Mfg:
Model:
ppm NOx @ %O
2
Is the drying or curing device permanently attached to the press? No Yes
If No, a separate permit is required for the drying or curing device.
Provide support document
Air Pollution Control
(APC)
Is printing equipment vented to APC equipment? No Yes
If Yes, a separate permit is required. If already permitted, permit no.: or application no.:
2
1
2
1 1
1
1
South Coast Air Quality Management District, Form 400-E-15 (2014.07)
South Coast Air Quality Management District
Form 400-E-15
Printing 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 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 D - Material Information
Identify all materials used in association with this equipment. Material Safety Data Sheets (MSDS) for all materials must be included.
Less water and exempt solvents
Including water and exempt solvents
Type of Materials
Coating VOC
(lbs VOC/gal coating)
Material VOC
(lbs VOC/gal material)
Weight% Oil
(Litho)
Average Amount Used
(gal/day)
Maximum Amount Used
(gal/day)
Ink #1
Ink #2
Plastisol Ink
Varnish, oil base
Varnish, water base
Ink, thinner
Other:
Other:
Type of Materials
Vapor Pressure
(mmHg @ 20
˚ Celsius )
Material VOC
(lbs VOC/gal material)
Average Amount Used
(gal/day)
Maximum Amount Used
(gal/day)
Clean Up Solvent
Blanket Wash
Roller Wash #1
Roller Wash #2
Other:
Fountain Solution
Mixing Ratio
(by Volume )
Material VOC
(lbs VOC/gal material)
Average Amount Used
(gal/day)
Maximum Amount Used
(gal/day)
Water
Alcohol
Alcohol Substitute
Etch/Concentrate
Other:
Section E - Equipment Operating Schedule
Operating Schedule
Normal:
hours/day days/week weeks/yr
Maximum:
hours/day days/week weeks/yr
Section F - 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.: Printing Equipment Section B - Equipment (SCAQMD)

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Completed 12 August 2020

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