Fill - Free fillable Gdf Form Equipment Worksheet And Instructions (Bay Area Air Quality Management District) PDF form

BAY AREA AIR QUALITY MANAGEMENT DISTRICT

GAS DISPENSING FACILITY FORM

New form for stand-alone GDFs only.

All fields are required unless otherwise noted. Please type or print.

Mail to:

BAAQMD

Engineering Division

375 Beale St., Suite 600

San Francisco, CA 94105

Tel: (415) 749-

Page 1 of 2 An electronic version of this form and instructions can be found at www.baaqmd.gov. v05/2016

1. Facility Information

Facility Name

BAAQMD Facility ID (Existing facilities only)

Facility Address (Street address and city)

2. General Information – BAAQMD Device ID is applicable if you received a Permit to Operate after March 5, 2012.

BAAQMD Device ID (if applicable)

Device/Operation Name

Initial/proposed date of operation

Device/Operation Description (Optional)

3. Operation Activities

Select the activity associated with this gasoline dispensing facility (GDF)? (Select one)

Refueling Motor Vehicles (retail) Refueling Motor Vehicles (non-retail) Refueling Agricultural Vehicles

Refueling Aircraft (directly) Refueling Marine Vessels

4. Tank and Vapor Recovery Information – Complete a section for each tank compartment at this GDF

 If you have more than 4 tanks or compartments, submit the additional information on a separate piece of paper.

Tank #1

Material Stored

Tank Type (Aboveground or Underground)

Tank/Compartment Volume (Gallons)

Manufacturer

Model

Phase I Vapor Recovery Type

Phase II Vapor Recovery Type

Tank #2

Material Stored

Tank Type (Aboveground or Underground)

Tank/Compartment Volume (Gallons)

Manufacturer

Model

Phase I Vapor Recovery Type

Phase II Vapor Recovery Type

Tank #3

Material Stored

Tank Type (Aboveground or Underground)

Tank/Compartment Volume (Gallons)

Manufacturer

Model

Phase I Vapor Recovery Type

Phase II Vapor Recovery Type

Tank #4

Material Stored

Tank Type (Aboveground or Underground)

Tank/Compartment Volume (Gallons)

Manufacturer

Model

Phase I Vapor Recovery Type

Phase II Vapor Recovery Type

BAY AREA AIR QUALITY MANAGEMENT DISTRICT

GAS DISPENSING FACILITY FORM

New form for stand-alone GDFs only.

All fields are required unless otherwise noted. Please type or print.

Mail to:

BAAQMD

Engineering Division

375 Beale St., Suite 600

San Francisco, CA 94105



 Tel:(415) 749-8665

Page2of2 Anelectronicversionofthisformandinstructionscanbefoundatwww.baaqmd.gov. v05/2016 



5. OperatingSchedule–Select“Continuous”orspecifyspecificscheduleinthe4columns



Continuous

Maximumhours/day Typicalhours/day Days/week Weeks/year





6. ProductDispensingNozzles

Enterthenumberofnozzlesyouhaveforeachofthefollowingproducts.Enter“0”ifthenozzletypedoesnotexist.

ProductType #ofNozzles ProductType #ofNozzles

Gasoline

–

SingleProductNozzle AVGas

Gasoline

–

DualProductNozzle Ethanol(E85)

Gasoline

–

TripleProductNozzle Jetfuel

Gasoline

–

FourProductNozzle Kerosene

Gasoline

–

FiveProductNozzle Methanol

DieselOtherLiquidFuel

Biodiesel



7. FacilityPlotPlan(Seeinstructions)

Ihavecompletedafacilityplotplanandattacheditwiththisform. Yes No



8. LiquidCondensateTrap



WhattypeofliquidcondensatetrapisusedatthisGDF?



9. MaterialUsage–Enterthemaximumannualusage(dispensed)foreachmaterialidentifiedinPart4

Material MaximumDispensed/Year

(Gallons)

Material MaximumDispensed/Year

(Gallons)





10. Certification/Signatureofpersonresponsiblefortheinformationonthisform.

Thisformcontainsconfidentialinformation. No Yes (IfYes,seeinstructions.)



IherebycertifythatIamauthorizedtocompletethisformforthefacilityandthatallinformationcontainedhereinistrue

andcorrect.

Name Title



Signature Date Phone(xxx‐xxx‐xxxx)

 



BAAQMDOfficeUseOnly–Skipthissection

Emissioncalculationmethodology

Defaultmethodologyused? Yes No



DownstreamDevices&Operations

ListanyabatementdevicesoremissionpointsthatareimmediatelydownstreamofthisGDF.

 

AbatementDeviceorEmissionPointName BAAQMDDeviceID



BAY AREA AIR QUALITY MANAGEMENT DISTRICT

GAS DISPENSING FACILITY EQUIPMENT WORKSHEET

All fields are required unless otherwise noted. Please type or print.

Mail to:

BAAQMD

Engineering Division

375 Beale St., Suite 600

San Francisco, CA 94105



 Tel:(415) 749-8665

Page1of1 Anelectronicversionofthisformandinstructionscanbefoundatwww.baaqmd.gov. v05/2016 



1. FacilityInformation

FacilityName BAAQMDFacilityID(Existingfacilitiesonly)



 BAAQMDDeviceID(Existingfacilitiesonly*)



 *Seeinstructions



2. NozzleTypes‐Provideinformationforequipmentthatdispensesgasoline,ethanol,methanoloraviationgas.



MaterialDispensed NozzleMake&Model MaterialDispensed NozzleMake&Model





3. DispenserInformation‐Provideinformationforequipmentthatdispensesgasoline,ethanol,methanoloraviationgas.



MaterialDispensed DispenserMake&Model MaterialDispensed DispenserMake&Model





4. AdditionalTankInformation

Areallgasolinestoragetanksfilledthroughasubmergedfillpipe?

Yes No

Forabovegroundgasolinestoragetanks,ifany,is/aredispenser(s)mountedonthetank?

Yes No N/A

IfnotoanyquestioninPart4,pleaseexplain.



5. OtherEquipment–Skipsectionsthatarenotapplicable

Make&ModelofLiquidCondensateTrap(s) Number



HowmanyblendingvalvesareatthisGDF?



6. Certification/Signatureofpersonresponsiblefortheinformationonthisform.

Thisformcontainsconfidentialinformation. 

No Yes (IfYes,seeinstructions.)

IherebycertifythatIamauthorizedtocompletethisformforthefacilityandthatallinformationcontainedhereinistrue

andcorrect.

Name Title



Signature Date Phone(xxx‐xxx‐xxxx)

 



BAY AREA AIR QUALITY MANAGEMENT DISTRICT

BAAQMD

Engineering Division

375 Beale St., Suite 600

San Francisco, CA 94105

Page 1 of 2 v05/2016

Instructions: Gas Dispensing Facility Form

Introduction

Use the following instructions to help guide you through the Gas Dispensing Facility

(GDF) form.

Who should use

this form?

This form should be submitted for all requested physical changes proposed for your

GDF. Some common physical changes include but are not limited to:

 Adding a storage tank

 Changing materials in a storage tank

 Changing Phase I and or Phase II vapor recovery systems

A Permit Application Cover form must accompany this form

What activities

at GDFs do not

require this

form?

The following activities at GDFs do not require a permit application:

 GDFs typically do not have abatement devices.

 GDFs typically do not require CEQA or PSD analysis.

 GDFs have volume emission points with emission generated from the outside.

 The upstream device for the emission point is typically the GDF.

Facility

Information

BAAQMD Facility ID - If you are an existing facility, fill out this field so that BAAQMD

can associate your changes to your facility. The facility ID is available on your permit or

invoice issued by BAAQMD.

General

Information

BAAQMD Device IDs – For GDFs, the device ID is a new identifier and will be listed on

your Permit to Operate if it was issued after March 1, 2012. Skip if this is not available.

Device/Operation Name – This is the name you associate to this GDF.

Initial/proposed date of operation – For new construction, enter the date that you

propose will be the initial date of operation. For a modification of an existing permitted

GDF, enter the date that you propose the changes to occur. For an existing GDF that is

not currently permitted by BAAQMD, enter the date for which the GDF initially

operated.

Device or Operation Description – This is your description of the device or operation.

This field can be used to distinguish it with other similar devices (e.g. ID numbers,

location), make, model and other similar information.

Operation

Activities

Refueling Motor Vehicles (retail) – GDFs that are used by the general public.

Refueling Motor Vehicles (non-retail) – GDFs that are not used by the general public.

Typical examples of this type are GDFs located at companies and car rental businesses.

Refueling Agricultural Vehicles – GDF used exclusively to fuel agricultural vehicles.

Refueling Aircraft (directly) – Fueling aircraft directly from the GDF, not fueling

aircraft by truck.

Refueling Marine Vessels – Fueling of boats and other marine vehicles.

BAY AREA AIR QUALITY MANAGEMENT DISTRICT

BAAQMD

Engineering Division

375 Beale St., Suite 600

San Francisco, CA 94105

Page 2 of 2 v05/2016

Tank and Vapor

Recovery

Information

For each tank or tank compartment enter the Material Stored. Refer to the list below.

There are two types of materials, regulated and non-regulated. This will be important

for other sections of the form.

Regulated Materials

Non-Regulated Materials

Gasoline

Diesel

Ethanol

Biodiesel

Methanol

Jet fuel

Aviation (AV) gas

Kerosene

 If other, enter name of material

Phase I and Phase II Vapor Recovery Types – See “Tables for the Gasoline Dispensing

Facility Form” at the end of these instructions for a current list of valid entries.

Product

Dispensing

Nozzles

This section is a count of all nozzle types at your GDF.

For gasoline, the type of product nozzle depends on the number of gasoline products

that can be dispensed through that nozzle. The most common types of nozzles are

single product and triple product nozzles. A gasoline dispenser will typically have 3

single product nozzles (one nozzle for each grade of gasoline) or 1 triple product nozzle

(a nozzle that can dispense 3 grades of gasoline).

Liquid

Condensate

Trap

Liquid Condensate Trap - A device designed to collect liquid that condenses in vapor

return lines to prevent liquid blockage.

See “Tables for the Gasoline Dispensing Facility Form” at the end of these instructions

for a current list of valid entries.

Operating

Schedule

A continuous operation is a GDF that is available for use 24 hours per day.

Material Usage

For each regulated material (see table above for list), enter the maximum throughput

that will be dispensed. The amounts will be your throughput limits that will be on your

permit. If this is unknown, enter “TBD” (for to be determined). Typically, the

throughput will be limited by the Health Risk Screening Analysis and other factors.

Still need help?

Call the Engineering Division at (415) 749-8665.

BAY AREA AIR QUALITY MANAGEMENT DISTRICT

BAAQMD

Engineering Division

375 Beale St., Suite 600

San Francisco, CA 94105

Page 1 of 1 v05/2016

Instructions: Gas Dispensing Facility Equipment Worksheet

Introduction

Use the following instructions to help guide you through the Gas Dispensing Facility

(GDF) Equipment Worksheet.

Who should use

this form?

This form is submitted for all permit applications except for applications for permit

condition changes only.

Facility

Identification

Facility Name – Enter the name as it appears on the BAAQMD permit or invoice.

BAAQMD Facility ID - The facility ID is available on the permit or invoice issued by

BAAQMD.

BAAQMD Device ID - The device ID is available on the permit issued by BAAQMD.

Nozzle Types

and Dispenser

Information

If any of the equipment dispenses gasoline, ethanol, methanol or aviation gas, enter

nozzle and dispenser information. Depending on your Phase II vapor recovery system,

only allowed equipment can be used, as approved by California Air Resources Board

(CARB) Executive Order.

Additional Tank

Information

Submerged Fill Pipe - Any discharge pipe or nozzle which meets either of the following

conditions:

1) Where the tank is filled from the top, the end of the discharge pipe or nozzle

must be totally submerged when the liquid level is 15 cm (6 inches) from the

bottom of the tank.

2) Where the tank is filled from the side, the discharge pipe or nozzle must be

totally submerged when the liquid level is 46 centimeters (18 inches) from the

bottom of the tank.

Other

Equipment

Liquid Condensate Trap – A device designed to collect liquid that condenses in vapor

return lines to prevent liquid blockage.

Blending Valve – A piece of equipment that blends (mixes) different grades of gasoline. An

example is blending 87 and 91 octane gasoline to make 89 octane gasoline.

Still need help?

Call the Engineering Division at (415) 749-8665.

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