2. Only for vacuum-cleaning systems used exclusively for housekeeping purposes and for sanding equipment using fabric filters with an air-to-cloth ratio of <3.5:1 (mechanical or reverse air cleaning) or <12:1 (pulse-jet cleaning)
4. AGENCY USE ONLY
6. Date
7. Registration No.
8. Notification No.
12. FACILITY INFORMATION
14. Company (or owner) Name
15. Registration No.
17. Address
19. City
20. State
21. Zip Code
23. Contact Name
24. Email Address
26. Phone Number
27. Fax Number
29. Applicant Name
31. Address
33. City
34. State
35. Zip Code
37. Installation Address
39. City
40. State
41. Zip Code
45. EQUIPMENT INFORMATION
47. Describe operation using the baghouse
49. Business Hours
50. Hours per Day
51. Days per Week
52. Weeks per Year
54. Estimated Installation Date
    Estimated Installation Date
56. Make
57. Model
59. 1. Pulse Jet

    1. Mechanical

    1. Reverse Air Cleaning
61. Airflow (ft3 /min, approximate)
63. Bag Diameter (inches, if round)
64. Bag Length (ft)
66. Filter Area (ft 2):
67. No. of Bags (total)
69. Air to Cloth Ratio per Manufacturer (cfm/ft 2 )
73. CERTIFICATION
75. I, the undersigned, do hereby certify that the information contained in this notification is, to the best of my knowledge, accurate and complete.
77. Name
78. Phone Number
79. Date
    Date
81. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
83. Electronic Signature
85. You must pay a $500 filing fee to complete this application. Please select an option for payment below.

    1. Pay by Check (print a copy of this application and mail with check)
    2. Pay by Credit Card (an accounting technician will contact person listed below for payment information)
87. Contact Person for Credit Card Payment
88. Contact Phone Number
Leave This Blank:


90. 1. Receive an email copy of this form.
91. Email address

    This field is not part of the form submission.

92. Submit Submit and Print

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