Fillable S Surface Coating Solvent Source DATA FORM T

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S Surface Coating Solvent Source DATA FORM T

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The S Surface Coating Solvent Source DATA FORM T form is 2 pages long and contains:

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  • 43 check-boxes
  • 112 other fields

Country of origin: US
File type: PDF

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BAY AREA AIR QUALITY MANAGEMENT DISTRICT
375 Beale Street, Suite 600, San Francisco, CA 94105 . . . (415) 749-4990
Fax (415) 749-5030 . . . www.baaqmd.gov
(if unknown, leave blank)
1. Business Name:
2. SIC No:
Date of Initial Operation (new):
Date of start-up (modification):
3. Name or Description
Source No.
S
4. Make, Model, and Rated Capacity of Equipment
5. Operating time:
hours/day
days/week
weeks/year
6. Typical % of total annual usage: Dec-Feb % Mar-May % Jun-Aug % Sep-Nov %
7. Solvent evaporation emissions at this source vent directly to: atmosphere (not through stack)
source(s): S S abatement device(s): A A emission point(s): P P
Complete one of the parts below. Check: Part A Part B Part C Part D** Part E Part F Part G
Part A - Surface Coater
8. Coater type: dipping flow coater roller coater spray booth other
9. If sprayer, check method: electrostatic (air-atomized) electrostatic (airless) electrostatic (disc)
air-atomized airless other
10. Does this coater apply only "complying" coatings as defined in BAAQMD Regulation 8? yes no
11. Of the total solvent in the coating(s), what percent evaporates at this source (applicator)? %
12. Check box if after application, heat is used for drying, baking, curing or polymerizing the coating. Complete another
form S for each dryer/oven, and specify Source Number(s) here: S S
Of the total solvent in the coating(s), estimate what percent evaporates in the dryer(s) %
13. Solvent used for cleanup at this source: Total, last 12 months gal Material Code*
Complete the following table for coatings as applied (after thinning, etc.)
Most Applied
Coating
2nd Most
Applied Coating
All Remaining
Coatings (total)
14. Material Code* for coating ----------------------------------------
15. Total coating applied, last 12 months (gal) -------------------
16. Percent Solids, by volume ----------------------------------------
%
%
%
17. Percent organic solvent, by volume ----------------------------
%
%
%
18. Density of organic solvent (lb/gal) ------------------------------
Composition of Organic Solvent:
19. a) largest component - % of organic solvent -------
%
%
%
20. - Material Code* --------------
21. b) 2nd largest component - % of organic solvent -------
%
%
%
22. - Material Code* --------------
Person completing this form:
Date:
** For printing presses, complete Part A, line #’s 14 through 22 Page 1 of 2
* See separate listing for Material Codes. If material is not listed, write name of material in place of code.
For Office Use Only
Plt #
S#
Initials
Date
FormS (revised: 4/12/16)
DATA FORM S
Surface Coating / Solvent Source
Data Form S - page 2 of 2 Plant No.__________________
Part B - Coating Dryer (If this source burns fuel, complete a Form C for it also)
23. Operation: hot air/gas dryer coating oven curing oven infrared other:
24. Temperature F oxygen present? yes no Which coating applicator(s)? S _ S _ S _
Part C - Solvent Cleaner
25. Operation: degreaser dry cleaning other:
26. Net solvent usage, total last 12 months: gal If solvent is heated, give temperature F
27. Is all solvent used in this source "complying" as defined in BAAQMD Regulation 8? yes no
28. Solvent used most: Material Code* density lb/gal percent of total used %
29. Solvent used 2nd most: Material Code* density lb/gal percent of total used %
Part D - Printing Press (Complete Part A, lines #’s 14 through 22 on Page 1)
30. Type: flexographic rotogravure letterpress lithographic silk screen other: :
31. Total ink used, last 12 months: lb or gal or tons
32. Total solvent used for cleanup, etc., last 12 months: gal Material Code*
Part E - Fiberglass Operation
33. Operation: dip layup molding spray (chopper gun) spray (other) other
34. Specify resin used
Total volume used, last 12 months gal
Volume percent styrene %
Volume percent other volatile organics %
35. Specify Catalyst used
Total volume used, last 12 months gal
36. Total solvent used for cleanup, etc., last 12 months gal
Material Code*
Part F - Manufacture of Coatings, Solvents, etc.
37. Solvent used for cleanup at this source: Total, last 12 months gal Material Code*
Highest Production
2nd Highest
Production
All Remaining
Production
38. Material manufactured (Material Code*)
...............................
39. Quantity manufactured, last 12 months (1,000 gal) ..............
40. Solvent used (Material Code*)
..............................................
41. Solvent evaporated during manufacturing, as volume% of
material produced
.................................................................
%
%
%
Part G Other Solvent Use (for tankage emissions, complete Form T)
42. Solvent evaporated most at this source:
Material Code*
Total evaporated, last 12 mo. gal
43. Solvent evaporated 2nd most at this source:
Material Code*
Total evaporated, last 12 mo. gal
* See separate listing for Material Codes. If material is not listed, write name of material in place of code.
FormS (revised: 4/12/16)
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Completed 18 April 2020

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