MONTEREY BAY UNIFIED AIR POLLUTION CONTROL DISTRICT

24580 SILVER CLOUD COURT!MONTEREY!CA 93940

PHONE (831) 647-9411!FAX (831) 647-8501

SURFACE COATING FACILITY SUPPLEMENTAL FORM

A. This form must be submitted with APCD Form #1, Application for Authority to Construct and Permit to Operate.
B. Each application must include applicable equipment specifications with plans and equipment location drawing, and MATERIAL SAFETY DATA SHEETS of all coatings and solvents used. Additional information may be required.
C. Further information or clarification may be obtained by writing or calling the Engineering Division at the Air Pollution Control District.
D. Both sides of this form must be filled out completely.
NOTE: Your Application for an Authority to Construct and a Permit to Operate must be approved prior to the commencement of any work. Any modification shall not be performed without first obtaining District approval.
1. Permit to be issued to:
2. Site Address: / 2a. Date Painting/Coating Started:
3. Location of Painting/Coating Area: / 3a. Nearest Neighbor or Business:
Distance ft. Direction
4. Type of Articles Coated: Wood Cabinets & Fixtures
Automobiles & Mobil Equipment
Metal Parts & Products
Other / 5. Usage of Coatings & Solvents:
Maximum Annually gallons
6. Method of Application: Spray gun Brush Roller Other:
7. Spray Gun Manufacturer Model No
Type: HVLP Conventional Airless Air Assisted Airless
8. Spray Booth Data or Painting/Coating Area Description:
a. Booth Manufacturer: Model No.: Serial No.:
b. Dimensions: Width Depth Height
c. No. Of Exhaust Fans: Fan Manufacturer:
Model No.: Hp: Rpm: Flow Rate: cfm
d. Intake Filters: Quantity Filter Size in. Long in. Wide in. Thick
Intake Filter Type: Pleated Paper (Andreae) Fiber Pad Styrofoam Other______
e. Exhaust Filters: Quantity: Filter Size in. Long in. Wide in. Thick
Exhaust Filter Type: Pleated Paper (Andreae) Fiber Pad Styrofoam Other
f. Water Wash: Pump Capacity: Gallons/min. Pump Hp
g. Stack Information: Height Above Ground ft. Inner Diameter (I.D.) in.
Type of Weather Cap: Auto Butterfly Damper Canopy Stationary Type
9. Drying Method: Air Dried Heat Dried (Temp F) Electric Gas
Burner Mfr: Rating MMBTU/HR
Date Received / 10. Signature of Responsible Official, Partner, or Sole Proprietor of Organization:
11. Type or Print Name and Official Title of Person Signing This Application:
Name Title Date

APCD FORM 404 (FORM404 surface coating.doc 05/06) (OVER)

MONTEREY BAY UNIFIED AIR POLLUTION CONTROL DISTRICT

SURFACE COATING FACILITY SUPPLEMENTAL FORM (continued)

12. Organic Material Data (Attach Material Safety Data Sheets, If Applicable)
Manufacturer / Product Name & Code No. / Mix Ratio / Maximum Daily Usage (gal/day)
Primer______
Thinner______
Hardener______/ ______
______
______/ ______/ ______
______
______
One Step Process
Enamel/Clear Coat______
Thinner______
Hardener______/ ______
______
______/ ______/ ______
______
______
Two Step Process
Base Coat______
Thinner______
Hardener______/ ______
______
______/ ______/ ______
______
______
Clear Coat______
Thinner______
Hardener______/ ______
______
______/ ______/ ______
______
______
Lacquer______
Thinner______
Hardener______/ ______
______
______/ ______/ ______
______
______
Stripping Compound
______/ ______/ ______/ ______
Clean-up Solvent______/ ______/ ______/ ______
Other______
______/ ______
______/ ______
______/ ______
______

APCD Form 404 (FORM404 surface coating.doc 05/06)