DNREC – Air Quality Management Section
Application to Construct, Operate, or Modify
Stationary Sources / Form AQM-3.6
Page 1 of 2
Cold Solvent Cleaner (Degreaser) Application
If you are using this form electronically, press F1 at any time for help
General Information
1.Facility Name:
2.Equipment ID Number:
3.Manufacturer:
4.Model:
5.Serial Number:
Operating Information
6.Cold Solvent Cleaner Type:Immersion
(Check All That Apply) Remote Reservoir
Spray Sink
Other (Specify):
If the Cold Solvent Cleaner is a Spray Sink, complete the rest of Question 6. If not, proceed to Question 7.
6.1.Pressure of Circulating Solvent:psipsi gaugeatminches watermm mercury
7.Cold Solvent Cleaner Tank Length:inchesfeetmeterscentimeters
8.Cold Solvent Cleaner Tank Width:inchesfeetmeterscentimeters
9.Cold Solvent Cleaner Tank Depth:inchesfeetmeterscentimeters
10.Cold Solvent Cleaner Freeboard Height:inchesfeetmeterscentimeters
11.Freeboard Ratio:
12.Is the Cold Solvent Cleaner Equipped With a Working Mode Cover? / YES NO
13.Is the Cold Solvent Cleaner Equipped With a Downtime Mode Cover? / YES NO
14.Is the Cold Solvent Cleaner Equipped With a Drainage Rack? / YES NO
If YES, complete the rest of Question 14. If NO, proceed to Question 15.
14.1.Are Parts Dried Before They Are Removed From the Drainage Rack? / YES NO
14.2.Drainage Rack Type: Internal
External
Other (Specify):
15.Is the Cold Solvent Cleaner Equipped with Drainage Return? / YES NO
16.Is Agitation Used? / YES NO
If YES, complete the rest of Question 16. If NO, proceed to Question 17.
16.1.Type of Agitation:Pumped
Air
Mechanical / Ultrasonic
Other (Specify):
17.Is the Cold Solvent Cleaner Equipped with an Internal Solvent Reclamation System? / YES NO
Solvent Information
18.Solvents Used
If there are more than five Solvents used, attach additional copies of this page as needed.
Solvent Name / Solvent Vapor Pressure at 68 °F (20 °C) / Molecular Weight / MSDS Attached?
18.1. / milimeters mercuryinches waterpsi / YES / NO
18.2. / milimeters mercuryinches waterpsi / YES / NO
18.3. / milimeters mercuryinches waterpsi / YES / NO
18.4. / milimeters mercuryinches waterpsi / YES / NO
18.5. / milimeters mercuryinches waterpsi / YES / NO
Attach a Material Safety Data Sheet (MSDS) for each Solvent used.
19.Total Amount of Solvent Contained in Cold Solvent Cleaner:gallonslitersquartspounds
20.Estimated Annual Solvent Consumption:gallonslitersquartspounds
21.Estimated Annual Solvent Disposal:gallonslitersquartspounds
22.Method of Solvent Disposal:Reclaimed
Disposed Off-Site / Disposed On-Site
Other (Specify):
Additional Information
23.Is There Any Additional Information Pertinent to this Application? / YES NO
If YES, complete the rest of Question 23.
23.1.Describe:

Final Application – Version 2created 2/2/09