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SPRAY EQUIPMENT SOLVENT CLEANER USAGE CHART

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					                       SPRAY EQUIPMENT SOLVENT CLEANER USAGE CHART
COMPANY NAME:                                                                                       ID #:
ADDRESS:
TELEPHONE NO:                                                                              PERMIT NUMBER:
PREPARED BY:                                                                               SIGNATURE:
SOLVENT -              NAME:
                       VOC of MATERIAL, lbs/gal:                                           % RECOVERY:
EQUIPMENT/METHOD:

FORM 109 MUST BE COMPLETED WITH THIS CHART. SEE BACK PAGE FOR ADDITIONAL INSTRUCTIONS.

                                                      AMOUNT OF SOLVENT (gallons)                                     SOLVENT
            DATE                                                                                              No.      USED
                                                                                                            of Days
              (a)                     ADDED (b)                  DISCARDED (d)                    USED       (g)      (AVE./DAY)
                                      [TOTAL] (c)               [RECOVERED] (e)                    (f)                   (h)




(Form 1-solcht3 and 1-solcht.4) C:\Docstoc\Working\pdf\c172cef8-6cb9-4270-805d-759fd4c5778d.doc
          INSTRUCTIONS FOR SPRAY EQUIPMENT SOLVENT CLEANER USAGE CHART

          SOLVENT:
                   NAME – Record name, type, code number of solvent used.
                   VOC of MATERIAL – Record VOC content of solvent in lbs/gal. Refer to Material Safety Data Sheet
                   (MSDS) or Technical Data Sheet from the manufacturer or call your supplier for information.
                   % RECOVERY – Record average % recovery calculated from two years of historical data supplied by
                   your waste solvent recycler. If waste solvent is not recycled apply 50% recovery.

          EQUIPMENT/METHOD: Record equipment or method used to clean material or application equipment.

          a) DATE – Record date (MM/DD) when you added solvent, discarded solvent, or operated solvent cleaner.

          b) Record amount of solvent added to solvent cleaner.

          c) Total amount of solvent added in between periods solvent cleaner was emptied for cleaning. Enclose this

                data with a bracket.

          d) Determine amount of solvent discarded when emptying solvent cleaner.

          e) Calculate amount of solvent recovered by multiplying amount of solvent discarded (d) % recovery.

                Enclose this data with a bracket.

          f)    Calculate amount of solvent used by subtracting amount recovered (e) from total amount added (c).

          g) Count number of days in between emptying of solvent cleaner.

          h) Calculate average solvent used per day by dividing amount used (f) by number of days (g).




(Form 1-solcht3 and 1-solcht.4) C:\Docstoc\Working\pdf\c172cef8-6cb9-4270-805d-759fd4c5778d.doc

				
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