Statewide Portable Equipment Registration Program

FORM 3-F - Application for Rock Drills*

(Auto-fill format. Press “Tab” or up/down arrows to enter information. Additional form information is provided on the reverse side.)

PERP Registration forms are available at http://www.arb.ca.gov/portable/portable.htm.

1. Company Name:
2. Equipment Listing:
Include the manufacturer, model, and serial number of the rock drill.
Is the unit self-propelled or on tracks? Yes No / Company Unit ID
Number (Optional):
Type / Manufacturer / Model / Serial Number
3. Maximum Throughput Rating: feet drilled/day
4. Home District Designation (Required):
5. Additional Information (If applicable. Attach another sheet if necessary):
*Please note: This form is used to register rock drill equipment units. If you wish to register the engine that drives a compressor or other component used to power the unit, please complete Form 2.


Form 3-F Instructions

1.  Company Name - Legal name of entity, business, organization, agency or private individual that operates equipment.

2.  Equipment Listing - List information regarding major components of equipment. Please provide all of the following:

Type – List as rock drill or any unique drill type.

Manufacturer - For example: Ingersol-Rand, etc.

Model - May be a series of numbers or letters or combinations of numbers and letters. For example: ECM-590.

Serial Number - A unique, unit specific number, usually on the equipment nameplate. The serial number is necessary to ensure that each piece of registered equipment can be uniquely identified and matched to its respective registration certificate number.

Company Unit ID (Optional) - For your reference. Enter your company unit or equipment number.

3.  Maximum Throughput Rating - Indicate the maximum drilling rate in feet per day.

4.  Home District Designation (Required) - Indicate the one air pollution control or air quality management district in which this engine will operate most of the time. Go to http://www.arb.ca.gov/capcoa/roster.htm for more information about air districts. A home district is required for each unit. To determine home district by location, go to http://www.arb.ca.gov/app/dislookup/dislookup.php.

5.  Additional Information - Include any supplemental information, if appropriate.

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