PUGET SOUND CLEAN AIR AGENCY 1904 3rd Ave, Ste 105 Seattle WA 98101-3317 Telephone: (206) 689-4052 or 1-800-552-3565 Fax: (206) 343-7522 www.pscleanair.org
QUESTIONNAIRE FOR REGISTRATION
Facility Name: Mailing Address: City, Zip: Facility Address: City, Zip: Phone Number: Email: Please describe your process. What do you make or do?
How much do you produce annually? How many hours of operation is this based on?
PRODUCTION EQUIPMENT (include combustion equipment like boilers, but do not include office equipment like computers) Equipment Type of Air Control Device Air Year Maximum Pollution Control Flow Rate (cfm) & Equipment & Type of Equipment * Production Device Diameter of Duct Control Capacity (if applicable) * (in)* Installed
* On the back of this form you will find a sample list of the types of equipment and air pollution controls that should be listed CERTIFICATION I, the undersigned, do hereby certify, that the information contained in this questionnaire is, to the best of my knowledge, accurate and complete. ______Signature Date ______Type or Print Name & Title Phone & Email Puget Sound Clean Air Agency personnel will review the information you submitted and will contact you regarding whether registration and/or permits for your equipment are needed.
Form No. 50-131 (08/2007 AZM) Generating Equipment Description Generating Equipment Description Control Equipment Description molding of rubber, plastics, abrasive blasting, outdoor composites and foams w/out styrene Catalytic afterburner monomer abrasive blasting/shot peening cabinet, refinery oil/water separator Flaring booth or room acid etching/chemical milling pickling tank Steam or water injection asphalt batch plant plating/anodizing Sulfur plant battery mfg printing press Activated carbon adsorption boiler, water heater or oil heater refinery process heater Venturi scrubber burn-off oven pulverizing Mat or panel filter chemical reactor rendering Refrigerated condenser chipper, shredder, hammermill, debarker, retort Barometric condenser hogger classifier sewage pump/regulator station Single cyclone clinker cooler smokehouse Chemical oxidation coffee roaster soil/groundwater remediation Water curtain cold solvent cleaner space heater Miscellaneous control composting spray booth, room or hangar Baghouse concrete batch plant spray coating, outdoor HEPA conversion coating spray dryer Catalytic oxidizer conveyor/elevator sterilizer Vapor recovery unit crematory still Afterburner crusher storage silo/bin Rotoclone curing oven storage tank Multiple cyclones dry cleaner storage tank w/ floating roof Electrostatic precipitator dryer storage tank w/ stage 1 Condenser engine test cell/stand stripping Demister fire training facility surface coating, non-spray Hvaf food and drug mfg thermal spraying Scr (selective catalytic reduction) Nscr (non-selective catalytic foundry sand handling tire buffer reduction) furnace turbine Wet scrubber galvanizing undefined Wet electrostatic precipitator gas pump nozzle w/ stage 2 vapor degreaser Mist eliminator - high efficiency gas pump nozzle w/o stage 2 wastewater evaporator Water sprays hazardous waste management wastewater treatment plant Screen IC engine welding/brazing/soldering Dry sorbent injection kiln incinerator Freeboard refrigeration device landfill laser/plasma torch loading/unloading machining/woodworking equipment melt furnace miscellaneous mixer molding of fiberglass, FRP, plastics and styrofoam w/ styrene monomer
Form No. 50-131 (08/2007 AZM)