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									              Forsyth County Office of Environmental Assistance and Protection
                           Paint Stripping and Miscellaneous Surface Coating Operations
                                  Subpart HHHHHH/ 40 CFR 63.11169 - 63.11180

                                            General Information
     Submit this form with all notifications.
1.   Facility Information
     Company/Facility Name:
     Physical Address:
                 Street:
                 City:                                                 Zip:
     Mailing Address (if different from physical address):
                 Street:
                 City:                                             State:             Zip:
     Phone:                              Fax:
     Email:

2.   Owner/Operator Information
     Name:                                                    Title: Owner
     Phone:                              Fax:
     Email:
     Mailing Address (if different):
                 Street:
                 City:                                             State:             Zip:

3.   Contact Person Information
     Name:                                                    Title:
     Phone:                              Fax:
     Email:

4.   Certifying/Responsible Official if different than "Owner"
     Name:                                                    Title:
     Phone:                              Fax:
     Email:

          It is recommended that all notifications be sent via certified mail so that you will have a record that
          this form was submitted to the regulatory agency.
          The complete standard is located in the Federal Regulations (40 CFR 63.11169 - 63.11180).
          A link to the standard is:
          http://www.epa.gov/fedrgstr/EPA-AIR/2008/January/Day-09/a24718.htm

     For assistance call or email:       Steve Lyda - 336-703-2444              lydask@forsyth.cc
                                         Bob Ragland - 336-703-2442             raglanre@forsyth.cc
           Forsyth County Office of Environmental Assistance and Protection
                          Paint Stripping and Miscellaneous Surface Coating Operations
                                 Subpart HHHHHH/ 40 CFR 63.11169 - 63.11180

                                            Initial Notification
     Complete and submit Sections 1-4. General Information with this form.
     For existing sources, the Initial Notification is due by January 11, 2010. For new sources, the Initial
     Notification is due 180 days after startup or July 7, 2008, whichever is later. A "New Source" is one that
     installed equipment after September 17, 2007.


5.   What is the date of installation of applicable equipment?


6.   Applicability
     a.   Paint Stripping Operations
          Do you use, or intend to use, methylene chloride (MeCl) to remove paint or other coatings from wood, plastic,
          metal, or other substrates?
                Yes. If "yes", you are subject to the standard. Complete Section 7, 9, and 10.
              No. If "no, you are not subject to this part of the standard. Complete Section 10.
     b.   Miscellaneous Coating Operations
          Do you spray a coating that contains a "target HAP" on metal or plastic substrates other than motor vehicles or
          mobile equipment? Target HAPS are chromium (Cr), lead (Pb), manganese (Mn), nickel (Ni), or cadmium
          (Cd).
                Yes. If "yes", you are subject to the standard. Complete Section 8, 9, and 10.
              No. If "no, you are not subject to this part of the standard. Complete Section 10.
     c.   Motor Vehicle or Mobile Equipment Coating Operations
          Do you spray apply coatings to motor vehicles or mobile equipment?

                Yes. If "yes", you are subject to the standard. Complete Section 8, 9, and 10.
                No. If "no, you are not subject to this part of the standard. Complete certification at Section 10.
                Yes, but my coatings do not contain chromium (Cr), lead (Pb), manganese (Mn), nickel (Ni), or cadmium
                (Cd) and I am applying for exemption. (Skip to Section 14)

7.   Paint Stripping Operations (if applicable)
     a.   Method of paint stripping (check all that apply)
                Chemical
                Mechanical
                Other (describe)
     b.   What substrate is stripped? (check all that apply)
                Wood
                Plastic
                Metal
                Other (describe)
     c.   Will you use more than 1 ton of methylene chloride in a year?
                Yes                No
8.   Surface Coating Operations (if applicable)
     a.       Type of surface coating operation (check all that apply)
                     Motor vehicle or mobile equipment coating
                     Miscellaneous coating of plastic or metal
     b.       Do you paint motor vehicles or mobile equipment at the customer's location?
                     Yes                No
     c.       Number of spray booths
                                           Type of wall's material
          Booth ID    # of walls                                          # of filters   Filter type
                                        (curtain, drywall, block, etc.)




     d.       Number of preparation stations.
     e.       Number of equipment clean up stations.
     f.       Number of painters usually employed.
     g.       Are painters fully trained?      yes              No         (See 12a for training requirements)
     h.       If you spray motor vehicles or mobile equipment, do the coatings contain a "target HAP"; cadmium (Cd),
              chromium (Cr), manganese (Mn), Nickel (Ni) or lead (Pb)?

                     Yes           No. If "no", see Section 14 if you want to apply for exemption.
9.   Compliance Status (See applicable section (11, 12, or 13) for summary of requirements)
     Existing sources (Compliance date is January 10, 2011)
                     The facility is currently in compliance with all requirements.
                     The certified Notification of Compliance (form 11, 12, or 13) may be submitted now but must be
                     submitted no later than March 11, 2011.
                     The facility will be in compliance with all requirements by January 10, 2011.
                     The certified Notification of Compliance (form 11, 12, or 13) must be submitted no later than March 11,
                     2011.
     New sources starting up after September 17, 2007 (Compliance date is the date of startup.)
                     The facility was in compliance at the time of startup.
                     The certified Notification of Compliance (form 11, 12, or 13) must be submitted with this Initial Notice.


                     The facility was not in compliance at the time of startup but is now in compliance.
                     The certified Notification of Compliance (form 11, 12, or 13) must be submitted with this Initial Notice.

                     The facility was not in compliance at the time of startup and is still not in compliance.
                     Complete certification at Section 10 and submit.
10.   Applicability Certification

           Is this facility subject to Subpart HHHHHH?
                 Yes                    No

      (If you answered "Yes" to any of the questions in Section 6, the facility is subject to Subpart HHHHHH.)

      The undersigned certifies under the penalty of law that all information and statements provided in this
      notification, based on information and belief formed after reasonable inquiry, are true, accurate, and
      complete.


      Signature of responsible company official listed in Section 2 or 4.              Date

      If you are not subject to this standard you do not need to proceed further. Sign and submit to the
      Forsyth County Office of Environmental Assistance and Protection.


      If you are subject to this standard, sign this certification and submit this form and other applicable forms
      to both the Forsyth County OEAP and US EPA.


           Bob Ragland                                                                 R. Douglas Neeley
           Program Manager                                                             Chief Air Toxics Monitoring Branch
           Forsyth County Office of Environmental Assistance and Protection            U.S. EPA, Region 4
           201 North Chestnut Street                                                   Sam Nunn Atlanta Federal Center
           Winston-Salem, NC 27101                                                     61 Forsyth Street, SW
                                                                                       Atlanta, GA 30303-3104

           It is recommended that all notices be sent by certified mail so that you will have a record that this
           form was submitted to the regulatory agency.

           The complete standard is located in the Federal Regulations (40 CFR 63.11169 - 63.11180).
           A link to the standard is:
           http://www.epa.gov/fedrgstr/EPA-AIR/2008/January/Day-09/a24718.htm

								
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