1MONTEREY BAY UNIFIED AIR POLLUTION CONTROL DISTRICT

24580 SILVER CLOUD COURT, MONTEREY, CA 93940 (831) 647-9411 FAX (831) 647-8501

FIBERGLASS FABRICATION SUPPLEMENTAL INFORMATION FORM

A. B. C. Both sides of this form must be filled out completely. This form must be submitted with APCD Form #1, Application for Authority to Construct and Permit to Operate. Each application must include applicable equipment specifications with plans and equipment location drawing. Additional information may be required. D. Further information or clarification may be obtained by writing or calling the Engineering Division at the Air Pollution Control District. NOTE: Your application for an Authority to Construct and a Permit to Operate must be approved prior to the commencement of any work. Any modification shall not be performed without first obtaining District approval. 1. 2. 3. Permit to be issued to: Mailing Address: Business Location: 4. Nearest Neighbor or Business: Distance: Direction: 5. Articles Manufactured: Resin, Fiberglassing Material & Solvent Information (Attach Material Safety Data Sheets): Manufacturer 6a. Polyester or Other Resin 6b. Finishing Resin 6c. Gel Coat 6d. Catalyst 6e. Mold Release 6f. Cleanup Solvent 6g. Adhesive 6h. Other(s) 7. 8. Waste Disposal Data - Name of Disposal Company: Fabrication Process(es) Used: Hand Lay-up Vacuum/Bag Molding Filament Winding Amount: Spray Lay-up Gal/Yr Product Name Maximum Daily Usage (Gal/Day) Mix Ratio Ft.

6.

Continuous Lamination Chopper Gun Other NOTE: SPECIFY THE MAKE AND MODEL OF THE APPLICABLE FABRICATION PROCESS UNITS.

9.

Emission Controls: Carbon Adsorption: Make: Total Number of Carbon Canisters in Use: In Series In Parallel Both Maximum Design Flow Through Carbon Bed: Thermal Oxidizer Make: Fuel Type: Catalyst Type: Maximum Fuel Consumption Rate: Catalytic Oxidizer Model: SCFM/GPM Rating: BTU/Hr Hrs of Operation Model: Carbon Weight per Canister: (Include Drawing on Back of Form) SCFM/Canister lbs

Life Expectancy
(Continued)

APCD FORM 412 (MSWordform.412) 04/06

MONTEREY BAY UNIFIED AIR POLLUTION CONTROL DISTRICT FIBERGLASS FABRICATION SUPPLEMENTAL INFORMATION FORM (continued) Venturi/Water Scrubber: Make: Maximum Design Flow Through Scrubber: Scrubber Dimensions: Ft. Diameter Model: Gal/acfm Ft. High

Spray Booth: (APCD Form 404 Must Be Completed For Spray Booth) Stationary Dust Collection System: (APCD Form 410 Must Be Completed For Dust Collector) Other 10. Exhaust Stack Information: Inside Diameter: Weather Cap: Yes in. No Height Above Ground: Exhaust Stack Temperature: ft. F Exhaust Stack Flow Rate: SCFM

Comments/Equipment Diagram/Location Drawing:

DATE RECEIVED

11.

Signature of Responsible Official, Partner, Or Sole Proprietor of Organization:

12.

Type or Print Name and Official Title of Person Signing This Application:

Name APCD FORM 412 (FORM412 fiberglass.doc) 05/06

Title

Date