Fillable South Coast Air Quality Management District Rule 1118.1 (SCAQMD)

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South Coast Air Quality Management District Rule 1118.1 (SCAQMD)

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South Coast Air Quality Management District, Rule 1118.1 Notification of Flare Inventory and Capacity Form (2019.1)
South Coast Air Quality Management District
Rule 1118.1 Notification of Flare Inventory and Capacity
Submit form by February 4, 2019
Section A – Operator Information
Section B – Equipment Location Address
1. Facility Name (Business Name of Operator):
4. Equipment Location Is:
Address
,
City State Zip
2. SCAQMD Facility ID
3. Owner’s Business Name (If different from Business Name of Operator):
Section C – Business Mailing Address
5. Correspondence Information:
Contact Name Title
Phone # Ext. E-Mail
Check here if same as equipment location address
Address
,
City State Zip
Section D – Flare Inventory and Capacity
Flare Number
(Serial # or I.D.)
Permit Number
Date of Flare
Installation
Type of Gas
Combusted
*
Maximum Rated Capacity
Fuel Meter
Installed?
Date of Last
Source Test
Size
MMscf/
hour
MMBtu/
hour
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
* 1 – Any gas in an open flare; 2 – Digester Gas; 3 – Landfill Gas; 4 – Produced Gas
Attach additional forms to report more flares
Section E – Authorization/Signature I hereby certify that all information contained herein and information submitted with this application are true and correct.
6. Signature of Responsible Official
7. Title of Responsible Official:
8. Print Name:
9. Date:
Mail To: SCAQMD
P.O.Box 4941
21865 Copley Dr.
Diamond Bar, CA 91765
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South Coast Air Quality Management District Rule 1118.1 (SCAQMD)

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Completed 15 May 2022

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