SAN DIEGO AIR POLLUTION CONTROL DISTRICT
SUPPLEMENTAL APPLICATION
INFORMATION
San Diego APCD Use Only
Appl. No.:
FEE SCHEDULES
59C
ID No.:
PORTABLE ASBESTOS MASTIC REMOVAL APPLICATION STATION
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Company Name:
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Equipment Address:
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•
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Attach a current Material Safety Data Sheet (MSDS) for each solvent to be used in this operation. (If VOC content
is not indicated on MSDS, please contact the manufacturer to obtain another supporting document.)
Attach a supporting document from the manufacturer for each solvent listed which indicates whether the solvent is
classified as photochemically or non-photochemically reactive.
Please type or print the information requested below.
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A.
EQUIPMENT DESCRIPTION
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Method(s) of solvent application: (Please check all applicable methods)
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Squeegees
Mops
Brushes
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Brooms
Buffers
Rags
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Other:
Rollers
Spray Guns
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B.
PROCESS DESCRIPTION
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a)
Describe all steps required to apply the solvent, including soaking time, dilution water used, etc.
b)
Describe all of the steps required to collect the waste solvent and mastic, including disposal methods.
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Rev. 3/04
1 of 2 (59C)
OVER
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C.
OPERATING SCHEDULE
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Maximum:
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D.
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Complete the table below for each solvent to be used (please provide a separate sheet if needed)
Days/Year
SOLVENT AND MATERIALS CONTAINING VOC'S
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Product
Manufacturer
Solvent
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Name of Preparer:
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Phone No.: (
Product
I.D. Number
Max. Use
(Gals/Day)
Max. Use
(Gals/Yr)
VOC
Content
Title:
Date:
)
NOTE TO APPLICANT:
Before acting on an application for Authority to Construct or Permit to Operate, the District may require further
information, plans, or specifications. Forms with insufficient information may be returned to the applicant for
completion, which will cause a delay in application processing and may increase processing fees. The applicant should
correspond with equipment and material manufacturers to obtain the information requested on this supplemental form.
2 of 2 (59C)