Fill - Free fillable Startup Notification Form (Bay Area Air Quality Management District) PDF form

BAY AREA AIR QUALITY MANAGEMENT DISTRICT

START-UP NOTIFICATION FORM

For notifying when new or modified devices have initiated operation

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

Mail to:

BAAQMD

Engineering Division

3 %HDOH St, 6XLWH

San Francisco, CA 9410



 Tel:(415) 749-4990

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



 Atleastseven(7)daysbeforethescheduledinitialoperation,completeandsubmitthisform.

 Submitoneformforeachdevice.

1. Facility&DeviceIdentification–EnterinformationasitappearsonyourAuthoritytoConstructpermit.



FacilityName BAAQMDFacilityID



ApplicationID BAAQMDDeviceID



2. Reasonforsubmittingthisform

Iamsubmittingthisformto:

(Selectone)

Notifyascheduledstart‐updateforthefirsttime

Reviseapreviouslyreportedstart‐update



3. Start‐upDate



Enterthescheduledstart‐updateforthedevicelistedinPart1.TheStart‐UpDateiswhenyouhavescheduledtobegin

operationofanewdeviceortobeingoperationofanexistingdevicewithnewmodificationstothatdevice.

ScheduledStart‐upDate(MM/DD/YYYY)



4. EquipmentSerialNumber–Forenginesanddrycleaningequipmentonly



Entertheserialnumberofthedevice.

SerialNumber



5. Start‐upRequirementsbyruleorpermitcondition



BeforeBAAQMDcanissueyourPermittoOperate,youmustdemonstratethatthedevicelistedinPart1wasbuiltas

authorizedandincompliancewithanystart‐uprequirementsbyconditionorrule.

A. WasthedevicebuiltasrepresentedinthepermitapplicationandasauthorizedbytheAuthoritytoConstruct?

Yes No

B. Doesthedevicehaveanyrequirementstomeetpriortoorduringthestart‐upperiod?

Yes No

C. If"Yes”toQuestion5B,hasthedevicealreadymetthoserequirements?

Yes No

 If“No”to5C,submitdocumentationthatdemonstratescompliancewithstart‐uprequirementswhencompleted.

D. If"Yes”toQuestion5C,hasdocumentationalreadybeenprovidedtoBAAQMDdemonstratingcompliancewiththe

start‐uprequirements?

Yes No

 If“No”5D,submitdocumentationthatdemonstratescompliancewithstart‐uprequirements.



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

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 1 v05/2016

Instructions: Start-Up Notification Form

Introduction

Use the following instructions to help guide you through the Start-Up Notification

Form.

Official notification is required when new and modified devices have initiated operation.

After notification and compliance with any start-up requirements, a Permit to Operate

for the device will be issued. Failure to meet these requirements may result in the

denial of the permit.

Who should use

this form?

This form is for:

➢ Notifying BAAQMD of a start-up date for devices permitted under an Authority

to Construct.

➢ Notifying BAAQMD of a change to a previously reported start-up date.

Facility &

Device

Identification

The information is available on your Authority to Construct.

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

your Permit to Operate if it was issued after March 5, 2012. Skip if this is not available.

Start-Up Date

The Start-Up Date is when you have scheduled to begin operation of a new device or to

begin operation of an existing device with new modifications to that device.

Start-up

Requirements

The device must be built as represented in the permit application and as authorized by

the Authority to Construct. There may also be requirements that must be met before or

during the start-up period. Some typical examples include but are not limited to:

➢ Initial source testing

➢ The shutdown of a replaced device

➢ Submission of information

Start-up period – The period of time between initial operation and the issuance or

denial of a Permit to Operate.

Unless otherwise stated in an Authority to Construct condition, all information for

demonstrating compliance with any start-up requirements should be submitted to the

attention of the Engineering Division. Include the BAAQMD Facility ID, Device ID,

application number and condition ID for all submissions.

Still need help?

Call the Engineering Division at (415) 749-4990.

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