Notification of Compliance Status for Perchloroethylene Dry Cleaning Facilities
Each owner or operator of a dry cleaning facility shall submit to the EPA and Kansas Department of Health and Environment by registered mail on or before July 28, 2008 a notification of compliance status providing the following information. The notification shall be signed by a responsible official who shall certify the accuracy of the notification.
Submittal of this form will satisfy the requirements of '63.324(f) of 40 CFR Part 63 Subpart M.
Operator Information (Name and address of the owner or operator of the dry cleaning facility):
( ) -
Name / Phone Number
Address
City / State / Zip Code
Address (physical location) of the dry cleaning facility:
Name of the dry cleaning facility / BAR Source ID
( ) -
Address of the dry cleaning facility (physical location) / Facility phone number
City / State / Zip Code
Is the perchloroethylene dry cleaning machine located in a building with a residence(s)?
Check yes even if the residence is vacant at the time of this notification.
(Check One) / Yes o / No o
Is the perchloroethylene dry cleaning operation a major or area source?
(Check One) / Area Source
o / Major Source
o / (Major source: a facility with only dry-to-dry machines and a total yearly perchloroethylene consumption 2100 gal. or a facility with only transfer machine systems or both dry-to-dry machine(s) and transfer machine systems and a total yearly perchloroethylene consumption 1800 gal. Area source: all perchloroethylene dry cleaning facilities that do not meet the definition of a major source)
Yearly perchloroethylene consumption:
Gallons / (Provide the sum of the volume of all perchloroethylene purchases made in the previous 12 months - i.e. the most recent Perc Consumption Running Total from your Dry Cleaning Compliance Calendar)
Is the perchloroethylene dry cleaning operation in compliance with each applicable requirement of 40CFR Part 63 Subpart M, '63.322?
Refer to the attached Subpart M Compliance Requirements Worksheet for compliance determination assistance.
(Check one) / Yes o / No o
Certification Statement: I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on information and belief formed after reasonable inquiry, including the person or persons who manage the system, or those persons directly responsible for gathering the information, the stated information in this document is true accurate and complete.
Name of Responsible Official (Print or type)
Signature of Responsible Official / Date
Submit before July 28, 2008 by registered mail to:
Richard Tripp
Air Permitting and Compliance Branch
US EPA, Region 7
901 N. 5th Street
Kansas City, KS 66101 / AND / Compliance and Enforcement Section
Bureau of Air and Radiation
Kansas Department of Health and Environment
1000 SW Jackson Street, Suite 310
Topeka, KS 66612-1366
For assistance or more information – contact SBEAP at 800-578-8898