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Permit - South Coast Air Quality Management District - 2013-12-11 SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT EMERGENCY INTERNAL COMBUSTION ENGINE (EMERGENCY ELECTRICAL GENERATOR) INFORMATION FOR END USER REGISTRATION PERMIT TO CONSTRUCT/OPERATE TO ACCOMPANY PERMIT APPLICATION FORM 400-A 1. BUSINESS NAME OF OWNER/OPERATOR 2. ENGINE DESCRIPTION: THIS INFORMATION MUST BE CONSISTENT WITH THE CERTIFIED EQUIPMENT PERMIT(CEP)ISSUED TO THE MANUFACTURER OR DISTRIBUTOR. ENGINE MANUFACTURER: c-1°WA/ . 1��6- ENGINE MODEL NUMBER: yo ?5 / c.S/3 ENGINE SERIAL NUMBER: T/'b ENGINE MODEL YEAR(Mfg) e 0/.3 ENGINE MAXIMUM RATING(STAND-BY): BHP( -5-6 kW) @ 1800 RPM(/POO RPM) CERTIFIED EQUIPMENT PERMIT NUMBER(Application No.)': ( 7/d I *PLEASE PROVIDE A COPY OF THE CERTIFIED EQUIPMENT PERMIT ISSUED TO THE ANUFACTURER/DISTRIBUTOR I 3.Is the equipment located within 1,000 feet from the outer boundary of a school? ❑ Yes No (If yes,complete for all public or private schools,grade K-12,within a 1/4 mile radius of the facility property) a. School Name: b. School Address: I, THE UNDERSIGNED, HAVE READ AND AGREE TO THE END USER CONDITIONS LISTED ON THE CERTIFIED EQUIPMENT PERMIT. I FURTHER UNDERSTAND THAT I WILL BE SUBJECT TO AN ANNUAL OPERATING PERMIT RENEWAL FEE, IN ADDITION TO THE PERMIT PROCESSING FEE, PURSUANT TO DISTRICT RULE 301(d). THE ABOVE INFORMATION IS SUBMITTED TO DESCRIBE THE EQUIPMENT FOR WHICH APPLICATION FOR PERMIT TO CONSTRUCT/OPERATE IS BEING MADE ON THE ACCOMPANYING FORM 400-A SIGNATURE OF RESPONSIBLE ' MEMBER OF FIRM: DATE /2- "-3 TYPE OR PRIT AND OFFIC ALTITLE NAME NAME: CO OF PERSON SIGNINGTHIS FORM TITLE: 6eI'LzWA 0.vt-nctsci Form EICE-RE(07/13) 1 '`7 " .'_+South Coast Air Quality Management District • Mail To: Form 400-CEQA SCAQMD California Environmental Quality Act (CEQA) Applicability m P•0.765 0944 - �P Diamond Bar;CA 91765-0944 3 Ad:_i � - Tel:,(909)396-3385 wwtv.agmd.gov The SCAQMD is required by state law,the California Environmental Quality Act(CEQA),to review discretionary permit project applications for potential air quality and other environmental impacts..This form isa_screening tool to assist the SCAQMD in clarifying whether or not the project' has=the potential to generate significant adverse environmental impacts,that might require preparation of'a"CEQA docurent[CEQA Guidelines§15060(a)j. 'Refer to the attached instructions for guidance in completing this form' For each Form 400-A application, also complete and submit one Form-400-CEQA. If'submitting multiple Form 400-A applications for the same project at the seine time,only one 400-CEQA form is necessary for the entire project.If you need assistance completing this form,contact Permit Services at(909)396-3385 or(909)396-2668. .. .. Section Ay Faciihty Information ; ,' '. -pmt- 7 ;�. ; >" Z J*- -� At t H 3 , 1.Facility Name(Business Name of Operator To Appear On The Permit) 2:Valid AQMD Facility ID(Available On Permit Or Invoice Issued C0STS r/E-6i'9 S�/v%T/ffC'S/ Arlsiwt,c,— By AQMD): 3.Project Description: - .. .. , ■ S� //7a � _5__ ?k iii G'>°i'�&7a of 1 . SectionB 'Review For Exemption'From Further CEQA Action 4 x -fi £ -.r�k- , - -� t Check'Yee or`No'as applicable ' °... - . - .- Yes No Is this application for - 1. f,} A CEQA and/or NEPA document previously or currently prepared that specifically evaluates this project? If yes,attach.a copy of the ` signed Notice of Determination to this form: 2. C) A.J A request for change of permittee only(without equipment modifications)? 3. C ' A functionally identical permit unit replacement with no increase in rating or emissions? _. - .. 4. . n C' A change of daily VOC permittimit:to a monthly VOC permit limit? - • - . - _ - 5. • ,_0 . „ Equipment damaged_as a result of a disaster during state of emergency?. . _ _ , ° . 6. ,Q _; A Title V I.e, Regulation XXX)permit renewal without equipment'modifiications)? ,,..• , . . 0 ; -_ A Title V adm nistratiye'permit revision? ' — 8. • "0 ' The conversion of an-existing'permit into an initial Title V permit? If'Yes'is checked for any question in}Section B,your application does not'require additional evaluation for CEQA applicability Skip,to Section D `Signatures on.;, page 2 and sign.and date.this form ', ._ x F Section-G-°'Revfewoffmpacts Which May Trigge�$GEQA �� 1 � - i x �-s� ��; 4 �tr �.� Y r.. ,. sr?s, . .:r�'mF�... ., �.bS.si. 't trcH,..r.sx`'`` a.*°z.=' .^x''.4'N�%:. 't .:�r Complete Parts I_-VI by checking'Yes'.,or'No'as applicable..To avoid delays,in processing your application(s),:explain all:°Yes"responses on a separate sheet; ; . and attach it to this form. Yes No Part I-General - 1. Has this project generated any known public controversy regarding potential adverse impacts that may be generated by the ' x.+ project? �. .; . ... . . . . C' /.'-\ Controversy may be construed as concerns raised by local groups at public meetings;adverse media attention such as negative articles in newspapers or other periodical publications,local news programs,environmental justice issues,etc. . 1., 2. r: ' • Is this project part of a larger project?If yes,attach a separate sheet to briefly describe the larger project. - Part II=Air Quality 3. f ,k- Will there be any demolition,excavating,and/or grading construction activities that encompass an area exceeding 20,000 square ' feet? 4. ,-. Does this project include the open outdoor storage of dry bulk solid materials that could generate dust? If Yes,include a plot plan with the application package. - . • 'A'project°means the whole of an action which has a potential for resulting in physical change to the environment,including construction activities,clearing or grading of land,improvements to existing structures,and activities or equipment involving the issuance of a permit. For example,a project might include installation of a new or modification of an existing internal combustion engine,dry-cleaning facility,boiler,gas,turbine,spray coating booth,solvent cleaning tank, etc. 2 To download the CEQA guidelines,visit http://ceres.ca.gov/env_law/state.html. 3 To download this form and the instructions,visit http://www.agmd.gov/ceqa or http:/hwww.agmd.gov/permit - ©South Coast Air Quality Management District,Form 400-CEQA 12009.04): u rrro _x `imom s r 7 s tg.- s c T 1* e ?j y r b "'�4 --.VO t -itt � -- : e Section C Review of Impacts Which May Tugger GEQA(writ)g � �, ,, , ,r ; *.. .� • ;.. 04„ :-- -,J,-.*::,.,-, �x:-�s;�„5.. v_.Zi:'r� ) .r w k�+.cx a I 1 .c.7ra� r :t_'z -i #'S � .4` s f. '}ti C - .t: - _ is Yes No Part Il Air Quality(coot) t , 1 ° -, 41 "' , ^ 't. ,�,s,. s _s .� ...ra.�.,,.__a. ." Ev?'.Y'_�i.hi�.<._od, r�_�,:?'z'.h,a.. .^� r., a-: . �: ._._-„.,<T'ro.. _ iY.. :t3-�.'C�Y?Ys. 5. Would this project result in noticeable off-site odors from activities that may not be subject to SCAQMD permit requirements? ' -'. 0 For example,compost materials or other types of greenwaste(i.e.,lawn clippings,tree trimmings,etc.)have the potential to generate odor complaints subject to Rule 402-Nuisance. 6. 0 Does this project cause an increase of emissions from marine vessels,trains and/or airplanes? , 7. C� • Will the proposed project increase the QUANTITY of hazardous materials stored,aboveground onsite or transported by mobile : ' f vehicle to or from the site by greater than or equal to the amounts associated with each compound on the attached Table 1?4 . , Part Ill Water Resources 8. Will the project increase demand for water at the facility by more than 5,000,000 gallons per day? The following examples identify some,but not all,types of projects that may result in a'yes°answer to this question:'1)projects that generate steam;2)projects that use water as part of the air pollution control equipment;3)projects that require water as part of the.: ,. production process;4)projects that require new or expansion of existing sewage treatment facilities;5)projects where water demand exceeds the capacity of the local water purveyor to supply sufficient water for the project;and 6)projects that require new or expansion of ' existing water supply facilities. 9. Will the project require construction of new water conveyance infrastructure? Examples of such projects are when water demands exceed the capacity of the local water purveyor to supply sufficient water for the f- project,or require new or modified sewage treatment facilities such that the project requires new water lines,sewage lines,sewage hook- ups; . .. _. ' Part:IV anspor n TrtationlCirculatio 10.` Will the project result in Check all that apply): r p< a. the need for more than 350 new employees? . ; s, , c, . b. an increase in heavy-duty transport truck traffic to andlor from the facility by more than 350 truck round-trips per day? 0 c. increase customer traffic by more than 700 visits_per day?;_ Part V Norse 11. .1 n I Will the project include equipment that will generate noise,GREATER THAN 90 decibels(dB)at the property lines . - Part VI Public Services 12. Will the project create a permanent need for new or additional,public services in any of the following areas(Check allthat apply): : ' 0” f` a. Solid waste disposal? Check"No"if the projected potential amount of wastes generated by the project is lessthan five tons per day. r - b. Hazardous waste disposal? Check'No'if the projected potential amount of hazardous wastes generated by theproject is less than 42 - e)- , / cubic yards per day(or equivalent in pounds). . •- - "REMIN DER For each'Yee response in Section C,attach all pertinent information including but not limited to estimated quantities,volumes,weights etc." ' raj' - a s s� '4.04,W1,44-56,1y,,; .;. ss'::''S A '�"a t y_ `1t `,rv- ii, i+ r+- :. :_°r11D.4Signa�Wy S,..1 ...: �.: ': -.,.�`R?s. ,� - I HEREBY CERTIFY THAT ALL-INFORMATION CONTAINED HEREIN AND INFORMATION SUBMITTED WITH THIS APPLICATION IS TRUE AND CORRECT:TO THE BEST OF MY KNOWLEDGE.1 UNDERSTAND THAT THIS FORM IS A-SCREENING TOOL AND THAT THE SCAQMD RESERVES THE RIGHT TO CONSIDER OTHER PERTINENT INFORMATION IN DETERMINING CEQA APPLICABILITY. 1.Signature of Responsible Official of Firm: 2.Title of Responsible Official of Finn: " .. . G enecc.) no e e--- 3.Print Name of Responsible Official of Firm: 4.Date Signed: '.6. C -K-CaV - \ -1 k-t 5.Phone#of Responsible Official of Firm: 6.Fax#of Responsible.Official of Firm: 7.Email of Responsible Official of Firm: G tCt- Ll5- ?�b Ct -6c-0- ,P2.5 scoac aVe ens 4O 8.Signatur Preparer,(If prepared by person other than responsible official of firm): : 9.Title'of Preparer: • T/ ? td�l��ov( 10.Print Name of Preparer 11.Date Signed: G(-ofe 66= ,'v,q ,/2 /o—i 3 12.Phone#of Preparer: 13.Fax#of Preparer. 14.Email of Preparec gsl-966`G77ii i-cD7 - /90 etvrkkr e(�ec-rrc � q•.4Qo..Cowr THIS CONCLUDES FORM 400-CEQA. INCLUDE THIS FORM AND ANY ATTACHMENTS WITH FORM 400-A. 4 Table 1-Regulated Substances List and Threshold Quantities for Accidental Release Prevention can be found in the Instructions for Form 400-CEQA. _ South Coast Air Quality Management District Mail To: -� '° Form 400-A SCAQMD A P.O.Box 4944 Application Form for Permit or Plan Approval Diamond Bar,CA 91765-0944 List only one piece of equipment or process per form. i Tel:(909)396-3385 ...... www.agmd.gov ,�, h YC } f 3 -5 "d' a y.J4 Sf w ti;i^+ ,Section A, `OPeratorinfortnatron7 ,,....__. .g _.�, _, t., _ ....:; . ,. _, : _. r;r '; l f .,4: - e 1.Facility Name(Business Name of Operator to Appear on the Permit): 2.Valid AQMD Facility ID(Available On COS 7/9/VC-S79 ,5,94//17 9/e y 0/Si X'%Ci Permit Or Invoice Issued By AQMD): 3.Owner's Business Name(If different from Business Name of Operator): Sectron'B Equipment LocatiOi Address .. ,r`;, ( , .r ;Section.0 Permit Mailing Address 4.Equipment Location Is: ,''Fixed Location ) Various Location 5.Permit and Correspondence Information: (For equipment operated at various locations,provide address of initial site.) ❑Check here if same as equipment location address 9 9 9 VC//C54•v s • 68 tY/ /..9-6-1t- S?"Z-7-e-T Street Address Address 0957/9 A' 4 ,CA 9C6 c) 7 CD,Si/9 /r96-.75c , 09 5d 6'7 City Zip City State Zip R 0.67 Ai/4, e---- 5 e M6/>%,e-- - X'o6' 7`/'/9'> 7f c=.v6,:vE -(c' Contact Name Title Contact Name , 7/ 3 -27d 7 3y3 y P-6.-/C 7/� -?93-27 7 9 9 -ms ,'- 63"/6 Phone# x— Fax# Phone# Ext Fax# E-Mail: /'oGll/zU CC)(i N&-7 E-Mail: .(`168yZ60 COX We- - Sectron°Dt.-APPlrcatton_:TyPe '° ', , ,.... VW- r 6.The Facility Is: 0 Not In RECLAIM or Title V C In RECLAIM 0 In Title V 0 In RECLAIM&Title V Programs 7.Reason for Submitting Application(Select only ONE): 7a New Equipment or Process A lication ,7c Equipment or Process with an Existing1Previous Application or Permit: r' New Construction(Permit to Construct) C,Administrative Change ._-. _....u._. ___,- -_...._ 0 Equipment On-Site But Not Constructed or Operational C:Alteration/Modification Existing or Previous o Equipment Operating Without A Permit' 0 Alteration/Modification without Prior Approval* PermiUApplication If you checked any of the items in C) Compliance Plan . 0 Change of Condition 7c.,you MUST provide an existing C) Registration/Certification C Change of Condition without Prior Approval' Permit or Application Number. C Streamlined Standard Permit 0 Change of Location 7b Facility Permits: : 0 Change of Location without Prior Approval' G The V Application or Amendment (Refer to Title V Matrix) 0 Equipment Operating with an Expired/Inactive Permit' C RECLAIM Facility Permit Amendment .'A Higher Permit Processing Fee and additional Annual Operating Fees(up to 3 full years)may apply(Rule 301(c)(1)(D)(q). 8a.Estimated Start Date of Construction(mm/dd/yyyy): 8b.Estimated End Date of Construction(mmldd/yyyy): 8c.Estimated Start Date of Operation(mm/dd/yyyy): /—/s=2o/ y 2i5-- eo/ey z-2o- 2©/ 9. Description of Equipment or Reason for Compliance Plan(list applicable rule): 10. For Identical equipment,how many additional applications are being submitted with this application? 5(r; kw 6 E/yF-/c#R2TGVec (Form 400-A required for each equipment/process) 11. Are you a Small Business as per AQMD's Rule 102 definition? 12. Has a Notice of Violation(NOV)or a Notice to (10 employees or less and total gross receipts are Comply(NC)been issued for this equipment? k No C Yes $500,000 or less OR a not-for-profit training center) No C Yes If Yes,provide NOVINC#: -+.- r �y - `� , d y"t- r a `$- i - -f .i+;: t- r a�c -'{' -. ., y Section;E Facility BUSrft@SS InformaUon�-_ . r..,�... A,,. ,,4xi. f .;y j`, t ,u ,_faa , 13. What type of business is being conducted at this equipment location? 14. What is your business primary NAICS Code? (North American Industrial Classification System) 15. Are there other facilities in the SCAQMD 16. Are there any schools(K-12)within jurisdiction operated by the same operator? C` No 0 Yes 1000 feet of the facility property line? No 0 Yes °Section F �Authonzation/S►gnatuerR-`4I eeby'eerbfy that all informaton conaned heem and rrortaton,ubmlted wthsapplrca6oare-:taand correcr M--;,°4 17.Signature of Responsible Official: 18.Title of Responsible Official: 19.1 wish to review the permit prior to issuance. , �/ (This may cause a delay in the S No . ' - azo (• c,,IS CC application process.) C' Yes 20.Print N e: 21.D te: 22. Do you claim confidentiality of EC( ( -- )\� \ \` \. data? (If Yes,see instructions.) No 0 Yes 23.Check List: ❑Authorized Signature/Date ❑Form 400-CEQA ❑Supplemental Form(s)(ie.,Form 400-E-xx) ❑Fees Enclosed �� �. APPLICATION TRACKING# CHECK# AMOUNT RECEIVED PAYMENT TRACKING# VAUDATION r at $ DATE_ APP f DATE APP CLASS BASIC EQUIPMENT CATEGORY CODE TEAM i ENGINEER REASOI:UACTION TAKEN REJ I REJ t IL CONTROL IIII ©South Coast Air Quality Management District,Form 400-A(2012.07)