Fillable X Additional Data DATA FORM T

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X Additional Data DATA FORM T

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U.S.A. forms for Bay Area Air Quality Management District

BROWSE BAY AREA AIR QUALITY MANAGEMENT DISTRICT (CA) FORMS

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for office use only
Form X is for additional information for an existing source only. If your company has not previously submitted any information for
this source, then do not complete Form X; use instead, the applicable Source Data Form(s) – C, G, S, T.
(if unknown, leave blank)
1. Business Name:
Plant No:
Source No.
2. Complete only one of the parts below. Check: Part 1 Part 2 Part 3 Part 4 Part 5
Part 1 – COMBUSTION SOURCE – Information for an additional fuel not previously reported.
3. Fuel Code* 12-month fuel consumption - total usage units* .
4. Typical percent of annual total: Dec-Feb % Mar-May % Jun-Aug % Sep-Nov %
5. Max. fuel use rate, usage units*/hr Typical heat content, BTU/usage unit*
6. Typical sulfur content, ppm for gaseous fuels, ppm or % wt for others %
7. Complete the Emission Factor Table at the end of this Form.
Part 2 – GENERAL SOURCE – Information for an additional process material not previously reported.
8. Material Code*
12-month throughput, total usage units*
9. Typical percent of annual total: Dec-Feb % Mar-May % Jun-Aug % Sep-Nov %
hours/day
days/week
weeks/year
11. Maximum operating rate usage units*/hr
12. Exhaust flowrate ______________CFM at F with approximate water vapor content %
13. Complete the Emission Factor Table at the end of this Form.
Part 3 – TANKAGE OR LOADING SOURCE – Information for an additional organic liquid not previously reported.
14. Material Code*
12-month throughput thousand gal or
thousand bbl
15. True vapor pressure psia or RVP psia and typical liquid temperature F
16. API (if applicable): Initial boiling point F
Part 4 – SURFACE COATING OR PRINTING PRESS - Information for an additional coating not previously reported.
17. Material Code* for coating Total coating applied, previous 12 months gal
18. Is this coating a "complying" coating as defined in BAAQMD Regulation 8, Rule 4? yes no
19. Percent solids, by volume ____________% Percent solvent, by volume %
20. Of the total solvent in the coating, what percent evaporates at this source? %
21. Density of organic solvent lb/gal
22. Composition of organic solvent:
a) largest component: percent of solvent %; Material Code* _
b) 2nd largest component: percent of solvent %; Material Code* _
Revised 4/12/16
Data Form X
Additional Data
BAY AREA AIR QUALITY MANAGEMENT DISTRICT
375 Beale Street, Suite 600 . San Francisco, CA 94105 . (415) 749-4990 . FAX (415) 749-5030
WEBSITE: WWW.BAAQMD.GOV
Data Form X - page 2
Part 5 - OTHER SOLVENT EVAPORATION SOURCE – Information for an additional solvent not previously reported.
For Solvent Cleaner Operation (degreasing, clean-up, drycleaning, etc.)
23. Material Code* Net solvent usage, previous 12 months gal
24. If solvent is heated, temperature of solvent F Density lb/gal
For Fiberglass Operations
25. Type of resin Total used, previous 12 months gal
26. Type of catalyst Total used, previous 12 months gal
27. Percent styrene in resin % Percent of other volatiles %
For Solvent and Surface Coating Manufacturing Operations
28. Material Code* of manufactured material
29. Quantity manufactured, previous 12 months thousand gal
30. Type of solvent used for manufacturing process, Material Code*
31. Solvent evaporated during manufacturing, as percent of material produced %
Other Solvent Use
32. Material Code* Total solvent used, previous 12 months gal
33. Is solvent "complying" as defined in BAAQMD Regulation 8? yes no
EMISSION FACTOR TABLE – To be completed for Parts 1 and 2
Emission Factors
(lb/Usage Unit)*
Basis Code**
34. Particulate ......................................
35. Organics ........................................
36. Nitrogen Dioxide (as N0
2
) ..............
37. Sulfur Dioxide ................................
38. Carbon Monoxide ..........................
39. Other:
40. Check box if above factors apply to emissions after abatement device(s).
*See Material Code listing
**See back of Data Form G for Basis Code table.
Person completing this form:
Date:
Revised 4/12/16
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Completed 18 April 2020

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