<p> Dealership Auto Body Shop Initial Notification Form For EPA Hazardous Air Pollution (HAP) Rule 40 CFR Part 63, Subpart HHHHHH</p><p>1. Dealership Auto Body Shop Name: </p><p>2. Dealer Information:</p><p>Name and Title: Street Address: Street City State Zip Telephone #: </p><p>Email: </p><p>3. Body Shop Manager Information:</p><p>Name and Title: </p><p>Street Address: Street City State Zip Telephone #: </p><p>Email: </p><p>4. Location of Compliance Records: </p><p>Are the compliance records located at the Body Shop? Yes No . If No, provide street address: </p><p>FORMTEXT Street City State Zip</p><p>5. Identification of Standard (you must check this box):</p><p>This Auto Body Shop is subject to 40 CFR Part 63, Subpart HHHHHH (National Emission Standards for Hazardous Air Pollutants: Paint Stripping and Miscellaneous Surface Coating Operations at Area Source)</p><p>1 5. Brief Description of Operations:</p><p>Motor Vehicle Surface Coating Operations: Number of: f a. Spray booths b. Preparation stations c. Painters usually employed </p><p>Paint Stripping Operations:</p><p> a. Methods of paint stripping employed (please check all that apply): Chemical</p><p>Mechanical Other (please describe) </p><p> b. Substrates stripped (please check all that apply): Plastic Metal Other (please describe) </p><p>6. Amount of Methylene Chloride (MeCl) Used by Paint Stripping Operations:</p><p>Does the Shop use more than 1 ton of MeCl annually? Yes No </p><p>7. Regulatory Compliance Status and Certification of Compliance:</p><p>The date by which this Notification Form must be filed and by which compliance must be achieved varies depending on whether the Dealership Auto Body Shop is “new” or “existing.” </p><p>New Shops (those that came into existence on or after September 17, 2007) must file this Form by no later than 180 days after “initial startup,” certifying compliance below. “Initial startup” is when equipment first is brought online in a paint stripping or surface coating operation, and paint stripping or surface coating is first performed. </p><p>Existing Shops (those that came into existence before September 17, 2007) must file this Initial Notification Form by no later than January 11, 2010, and must certify compliance by no later than March 11, 2011. </p><p>This Auto Body Shop: </p><p>1. Please check one: Is New Is Existing Shop Initial startup date: 2. Please check one: Has complied with the relevant standards. Will comply by the appropriate due date</p><p>For Surface Coating Operations, the relevant standards are set out in 40 CFR 63.11173(e) through (g). For Paint Stripping Operations, the relevant standards are set out in 40 CFR 63.11173(a) through (d).</p><p>8. Certification </p><p>1. For new Auto Body Shops, the Dealer or Manager listed above must certify compliance by signing below. </p><p>2. For existing Auto Body Shops, the Dealer or Manager listed above must certify compliance by signing below or may certify once compliance is achieved, but by no later than March 11, 2011.</p><p>Please check one: I am certifying below I am not certifying now but will do so by March 11, 2011. </p><p>I certify the truth, accuracy, and completeness of this notification. </p><p>2 Submit Initial Notification Form as follows: a. To the appropriate Regional Office of the EPA (see addresses below); and b. To the appropriate Local Ohio agency found at the following link: http://www.4cleanair.org/contactStateLevel.asp? selectState=47 </p><p>Address of EPA Regional Office:</p><p>EPA Region V, Director, Air and Radiation Division, 77 West Jackson Blvd., Chicago, IL 60604–3507.</p><p>Signature of Dealer or Auto Body Shop Manager: Printed Name: </p><p>3</p>