Location Wheretheequipment Willbeoperated

SanJoaquinValleyAirPollutionControlDistrictSupplementalApplicationForm

ConcreteBatchPlants

This form must be accompanied by a completed Authority to Construct/Permit to Operate Application form

PERMITTOBEISSUEDTO:

LOCATION WHERETHEEQUIPMENT WILLBEOPERATED:

EQUIPMENT DESCRIPTION

Batch Plant Data / Manufacturer(ifapplicable):
ModelNumber(ifapplicable):
MaximumRatedHorsepowerofallelectric motors:hp
Istheoperationpoweredbyaninternalcombustionengine?[]No[]Yes(Note:If engine is rated atgreater than50 hpanICEngine SupplementalApplicationformis required.)
CementSilo(s) Data / TotalNumberofSilos: / Volume ofeachsilo:galorft3(circleone)
Typeoffilter:[]FabricFilter[]CartridgeFilter[]Other(pleasespecify):
FlyAshSilo(s) Data / TotalNumberofSilos: / Volume ofeachsilo:galorft3(circleone)
Typeoffilter:[]FabricFilter[]CartridgeFilter[]Other(pleasespecify):
Silo Control / []Yes(Baghouse/DustCollectorsupplementalapplicationrequired) []No

MaximumCementSilo LoadingThroughput

MaximumCementSilo UnloadingThroughput MaximumFlyAshSilo

LoadingThroughput

MaximumFlyAshSilo UnloadingThroughput MaximumAggregate

Throughput

PROCESSDESCRIPTION

ton/hr

ton/hr

ton/hr

ton/hr

ton/hr

ton/day

ton/day

ton/day

ton/day

ton/day

ton/yr ton/yr ton/yr ton/yr ton/yr

MaximumSandThroughputMaximumConcreteOutput

ton/hr

yd3/hr

ton/day

yd3/day

ton/yr yd3/yr

ProvideanEquipment Listing,SitePlan,and MaterialFlowChart (onaseparatesheetofpaper)

a)Provideanequipmentlistingtoincludethemanufacturerandmodelnumberofall majorcomponents.

b)ProvideatypicalSitePlanforamaximumthroughputscenario(includeallprocess,control,andtransfer equipment).

c)ProvideaMaterialFlowChartforamaximumthroughputscenario.(Includeallprocess,control,and transferequipment,theirtypes,andtheirmaximumratings.Alsoinclude transferpoints, stockpiles,and

airpollutioncontrol methods.

Northern Regional Office * 4800Enterprise Way * Modesto, California 95356-8718 * (209)557-6400 * FAX (209) 557-6475

Central Regional Office * 1990East GettysburgAvenue *Fresno,California 93726-0244 * (559)230-5900 * FAX(559) 230-6061

Southern Regional Office * 34946 Flyover Court* Bakersfield,California93308* (661) 392-5500 * FAX (661) 392-5585

Revised: January 2009

PROCESS DESCRIPTION (Continued)

Isthisa“WetMix”type plant? / []Yes[]No / Isthisa“TransientMix” drytypeplant? / []Yes[]No
MechanicalCementTransfer Points / NumberofPoints: / Quantityoftransferpointscontrolledby:
[]FabricFilter[]BinVentFilter[]Other(pleasespecify)[]None
PneumaticCementTransfer Points / NumberofPoints: / Quantityoftransferpointscontrolledby:
[]FabricFilter[]BinVentFilter[]Other(pleasespecify)[]None
CementWeighHopper TransferPoints / NumberofPoints: / Quantityoftransferpointscontrolledby:
[]FabricFilter[]BinVentFilter[]Other(pleasespecify)[]None
MechanicalFlyAshTransfer Points / NumberofPoints: / Quantityoftransferpointscontrolledby:
[]FabricFilter[]BinVentFilter[]Other(pleasespecify)[]None
PneumaticFlyAshTransfer Points / NumberofPoints: / Quantityoftransferpointscontrolledby:
[]FabricFilter[]BinVentFilter[]Other(pleasespecify)[]None
FlyAshWeighHopper TransferPoints / NumberofPoints: / Quantityoftransferpointscontrolledby:
[]FabricFilter[]BinVentFilter[]Other(pleasespecify)[]None
MechanicalAggregate TransferPoints / NumberofPoints: / Quantityoftransferpointscontrolledby:
[]FabricFilter[]BinVentFilter[]WaterSpray[]Other[]None
MechanicalSandTransfer Points / NumberofPoints: / Quantityoftransferpointscontrolledby:
[]FabricFilter[]BinVentFilter[]Other(pleasespecify)[]None
SandandAggregateWeigh HopperTransferPoints / NumberofPoints: / Quantityoftransferpointscontrolledby:
[]FabricFilter[]BinVentFilter[]WaterSpray[]Other[]None
ConcreteTransferPoints (TruckLoading) / NumberofPoints: / Quantityoftransferpointscontrolledby:
[]FabricFilter[]BinVentFilter[]WaterSpray[]Shroud[]None

PLANTLAYOUT DESCRIPTION

Total AreaofUnpaved Roadswithinthe Plant / Area:acreorft2(circleone) / Typeofcontrol:[] Water[]Oil/DustPalliate []Other(pleasespecify):
Total AreaofAggregate PileswithinthePlant / Area:acreorft2(circleone) / Type ofcontrol:[]Water[]PhysicalCovering []Retaining Walls[]Other(pleasespecify):

HEALTH RISK ASSESSMENT DATA

OperatingHours / MaximumOperatingSchedule:hoursperday,andhoursperyear
ReceptorData / DistancetonearestResidence / feet / Distanceismeasuredfromtheproposedstacklocationtothenearestboundaryofthenearestapartment,house,dormitory,etc.
Directiontonearest
Residence / Directionfromthestacktothereceptor,i.e.NorthorSouth.
Distancetonearest
Business / feet / Distanceismeasuredfromtheproposedstacklocationtothe
nearestboundaryofthenearestofficebuilding,factory,store,etc.
Directiontonearest
Business / Directionfromthestacktothereceptor,i.e.NorthorSouth.
Stack Parameters / ReleaseHeight / feetabovegrade
StackDiameter / inchesatpointofrelease
RainCap / []Flapper-type[]Fixed-type[]None[]Other:
DirectionofFlow / []VerticallyUpward[]Horizontal[]Other:fromvert.orfromhoriz.
Exhaust Data / Flowrate:acfm / Temperature:F
Facility Location / []Urban(areaofdensepopulation) []Rural(areaofsparsepopulation)

Describeanyadditionalairpollutioncontrolequipmentor technologies,includingcontrolefficiencies, onaseparatesheetandsubmitit alongwiththisform.

FORDISTRICTUSEONLY

Date: / FID: / Project: / PublicNotice:YN
Comments: