SAN DIEGO AIR - Air Pollution Control District

SAN DIEGO AIR POLLUTION CONTROL DISTRICTSUPPLEMENTAL APPLICATIONINFORMATIONFEE SCHEDULE09ASan Diego APCD Use OnlyAppl. No.:ID No.:CONCRETE PRODUCTS MANUFACTURING PLANT12345Company Name:Equipment Address:1. MIXING EQUIPMENT DESCRIPTION (08D)Mixer Type: Dry Wet Capacity: Cu. Yd.Mixer Manufacturer:6Model:S/N:78910Product Composition: % Sand %Agg. % CementMaximum Throughput (Dry): lbs/hr lbs/wkOperating Schedule: hrs/day days/week weeks/yearMethod of sand and aggregate storage and capacity:111213141516Cement storage silo capacity:Method of product curing:Boiler Manufacturer:Model:Cu. Yd.S/N171819Rated input: BTU/hr Fuel Type2. EMISSION CONTROL EQUIPMENTDescribe mixing emission control equipment:202122Describe material storage emission control equipment:2324Rev. 3/03 1 of 2 (09A) OVER

2526Baghouse Manufacturer:Model:S/N2728No of Bags Total Fabric Area: Ft 2Fan Manufacturer:29Model:S/N30Fan Rating: cu. ft/min Actual Flowrate to Baghouse cu ft/minAttach a diagram of the manufacturing process including materiel conveyance, equipment locations,ventilation flow rates, and manufacturer's specifications.31Name of Preparer:Title:32Phone No.: ( ) Date:NOTE TO APPLICANT:Before acting on an application for Authority to Construct or Permit to Operate, the District may requirefurther information, plans, or specifications. Forms with insufficient information may be returned to theapplicant for completion, which will cause a delay in application processing and may increase processingfees. The applicant should correspond with equipment and material manufacturers to obtain the informationrequested on this supplemental form.2 of 2 (09A)