California > Statewide > South Coast Air Management District > Permit Application
Form 400-A Application For Permit To Construct And Permit To Operate 400-A - California
| Form 400-A Application For Permit To Construct And Permit To Operate Form. This is a California form and can be used in Permit Application South Coast Air Management District Statewide . |
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6RXWK &RDVW $LU 4XDOLW\ 0DQDJHPHQW 'LVWULFW Form 400-A Application Form for Permit or Plan Approval /LVW RQO\ RQH SLHFH RI HTXLSPHQW RU SURFHVV SHU IRUP Mail To: 6&$40' 32 %R[ 'LDPRQG %DU &$ 7HO ZZZDTPGJRY 2. Valid AQMD Facility ID $YDLODEOH 2Q 3HUPLW 2U ,QYRLFH ,VVXHG %\ $40' Section A - Operator Information 1. Facility Name %XVLQHVV 1DPH RI 2SHUDWRU WR $SSHDU RQ WKH 3HUPLW : 3. Owner's Business Name ,I GLIIHUHQW IURP %XVLQHVV 1DPH RI 2SHUDWRU Section B - Equipment Location Address 4. Equipment Location Is: Fixed Location Various Location )RU HTXLSPHQW RSHUDWHG DW YDULRXV ORFDWLRQV SURYLGH DGGUHVV RI LQLWLDO VLWH 6WUHHW $GGUHVV &LW\ &RQWDFW 1DPH 3KRQH (0DLO ([W , CA 7LWOH )D[ =LS Section C - Permit Mailing Address 5. Permit and Correspondence Information: &KHFN KHUH LI VDPH DV HTXLSPHQW ORFDWLRQ DGGUHVV $GGUHVV &LW\ &RQWDFW 1DPH 3KRQH (0DLO ([W , 6WDWH =LS 7LWOH )D[ Section D - Application Type 6. The Facility Is: Not In RECLAIM or Title V In RECLAIM In Title V In RECLAIM & Title V Programs 7. Reason for Submitting Application 6HOHFW RQO\ 21( : 7a. New Equipment or Process Application: 1HZ &RQVWUXFWLRQ 3HUPLW WR &RQVWUXFW (TXLSPHQW 2Q6LWH %XW 1RW &RQVWUXFWHG RU 2SHUDWLRQDO (TXLSPHQW 2SHUDWLQJ :LWKRXW $ 3HUPLW * &RPSOLDQFH 3ODQ 5HJLVWUDWLRQ&HUWLILFDWLRQ 6WUHDPOLQHG 6WDQGDUG 3HUPLW 7b. Facility Permits: 7LWOH 9 $SSOLFDWLRQ RU $PHQGPHQW 5HIHU WR 7LWOH 9 0DWUL[ 5(&/$,0 )DFLOLW\ 3HUPLW $PHQGPHQW 8a. Estimated Start Date of Construction PPGG\\\\ : 7c. Equipment or Process with an Existing/Previous Application or Permit: $GPLQLVWUDWLYH &KDQJH $OWHUDWLRQ0RGLILFDWLRQ $OWHUDWLRQ0RGLILFDWLRQ ZLWKRXW 3ULRU $SSURYDO * &KDQJH RI &RQGLWLRQ &KDQJH RI &RQGLWLRQ ZLWKRXW 3ULRU $SSURYDO * &KDQJH RI /RFDWLRQ &KDQJH RI /RFDWLRQ ZLWKRXW 3ULRU $SSURYDO * (TXLSPHQW 2SHUDWLQJ ZLWK DQ ([SLUHG,QDFWLYH 3HUPLW * * $ +LJKHU 3HUPLW 3URFHVVLQJ )HH DQG DGGLWLRQDO $QQXDO 2SHUDWLQJ )HHV XS WR IXOO \HDUV PD\ DSSO\ 5XOH F ' L Existing or Previous Permit/Application ,I \RX FKHFNHG DQ\ RI WKH LWHPV LQ F \RX 0867 SURYLGH DQ H[LVWLQJ 3HUPLW RU $SSOLFDWLRQ 1XPEHU 8b. Estimated End Date of Construction PPGG\\\\ : 8c. Estimated Start Date of Operation PPGG\\\\ : 9. Description of Equipment or Reason for Compliance Plan OLVW DSSOLFDEOH UXOH : 10. For Identical equipment, how many additional applications are being submitted with this application? )RUP $ UHTXLUHG IRU HDFK HTXLSPHQW SURFHVV 12. Has a Notice of Violation (NOV) or a Notice to Comply (NC) been issued for this equipment? If Yes, provide NOV/NC#: No Yes 11. Are you a Small Business as per AQMD's Rule 102 definition? HPSOR\HHV RU OHVV DQG WRWDO JURVV UHFHLSWV DUH No RU OHVV OR D QRWIRUSURILW WUDLQLQJ FHQWHU Yes Section E - Facility Business Information 13. What type of business is being conducted at this equipment location? 15. Are there other facilities in the SCAQMD jurisdiction operated by the same operator? 14. What is your business primary NAICS Code? 1RUWK $PHULFDQ ,QGXVWULDO &ODVVLILFDWLRQ 6\VWHP Yes 16. Are there any schools (K-12) within 1000 feet of the facility property line? No Yes No Section F - Authorization/Signature 17. Signature of Responsible Official: 20. Print Name: 23. Check List: AQMD USE ONLY '$7( I hereby certify that all information contained herein and information submitted with this application are true and correct. 18. Title of Responsible Official: 19. I wish to review the permit prior to issuance. 7KLV PD\ FDXVH D GHOD\ LQ WKH DSSOLFDWLRQ SURFHVV 21. Date: 22. Do you claim confidentiality of No data? ,I Link/Embed this Document |
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