2700-FM-AQ0113
6/2007
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF AIR QUALITY
EXEMPTION FROM 2006 AIM COATINGS COMPLIANCE ASSESSMENT
(Please submit this form if you believe your company is not subject.)
Pennsylvania 2006 AIM Coatings Compliance Assessment (http://www.dep.state.pa.us/dep/deputate/airwaste/aq/default.htm)
Company Name:
Web Site:
Division:
Address:
City:
State:
Zip:
Contact Person:
Title:
Phone:
FAX:
Email:
We are not completing the Pennsylvania Department of Environmental Protection’s (Department) 2006 Compliance
Assessment of Architectural and Industrial Maintenance Coatings Distributed in Pennsylvania in 2005 (2006
Compliance Assessment) because (check one):
We are not a paint manufacturer/importer/distributor.
We are a paint distributor and the manufacturer of products “manufactured for” us or “distributed by” us is
completing the compliance assessment. That manufacturer is:
We are a parent/holding company of a paint manufacturer/importer/distributor and that subsidiary
manufacturer/importer/distributor is completing the compliance assessment.
That subsidiary
manufacturer/importer/distributor is:
We are a paint manufacturer/importer/distributor, but our parent/holding company is completing the compliance
assessment for us. That parent/holding company is:
We are a paint manufacturer/importer/distributor, but we did not have sales of architectural coatings in
Pennsylvania in 2005.
Other (Please explain):
Name:
Title:
Signature:
Date:
Telephone Number:
Email:
Note: This form must be signed and submitted to the Department as an original paper copy.