Form AFR-232 "Nysdec Air Facility Registration Application for Dry Cleaners Using Perchloroethylene and/Or Approved Alternative Solvents" - New York

What Is Form AFR-232?

This is a legal form that was released by the New York State Department of Environmental Conservation - a government authority operating within New York. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on May 7, 2018;
  • The latest edition provided by the New York State Department of Environmental Conservation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form AFR-232 by clicking the link below or browse more documents and templates provided by the New York State Department of Environmental Conservation.

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Download Form AFR-232 "Nysdec Air Facility Registration Application for Dry Cleaners Using Perchloroethylene and/Or Approved Alternative Solvents" - New York

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NYSDEC AIR FACILITY REGISTRATION APPLICATION for Dry Cleaners using Perchloroethylene
and/or Approved Alternative Solvents
DEC ID #
Taxpayer ID #
1. Owner’s Name:
2. Owner’s Mailing Street Address:
3. City / Town:
4. State or Province:
5. Country:
6. ZIP/Postal Code:
7. Facility Owner/Manager (O/M) Name:
8. O/M Certification No. (Perc Only):
9a. Phone No.:
9b. Fax No.:
9c. email Address:
(
)
(
)
10. Facility Name:
11. Location Address:
12. City / Town:
13. State:
14. ZIP Code:
New York
15. Building Information:
❑ Vapor Barrier Installed
❑ General Exhaust Ventilation System Installed
a. Control Systems (check all that apply):
❑ Stand-Alone (No other building occupants)
❑ Co-located (Other building occupants)
b. Building Type (check one):
❑ Residences
❑ Senior Center
❑ Medical Office
❑ Exercise/Gym/Dance Studio
❑ Coin Laundromat
c. Co-located: check all boxes to
❑ Day Care/Pre-School
❑ School
❑ Retail Store
❑ Restaurant/Food Service
❑ Other Business
describe other types of tenants;
DRY CLEANING MACHINES (
Use additional form(s) to describe more than 3 machines)
Capacity
Year
Date
Solvent
Solvent
Spill Pan
Machine
Machine Manufacturer
Model Number
Serial Number
1
2
lbs.
Mfd.
Installed
Type
Gal/Yr*
(Y/N)
Type
16a.
17a.
18a.
19a.
20a.
21a.
22a.
23a.
24a.
25a.
/
/
16b.
17b.
18b.
19b.
20b.
21b.
22b.
23b.
24b.
25b.
/
/
16c.
17c.
18c.
19c.
20c.
21c.
22c.
23c.
24c.
25c.
/
/
1
Name all primary dry cleaning solvents given a
26. Other Solvent(s):
Solvent Type “Z” in Box 22a, 22b, or 22c.
2
Describe all dry cleaning machines given a
27. Other Machine(s):
Machine Type “Z” in Box 25a, 25b, or 25c.
CERTIFICATION: I certify that this facility will be operated in conformance with all provisions of existing regulations.
Responsible Official:
Title:
Signature:
Date:
*Refer to instructions for special guidance.
Form AFR-232 (5-07-2018)
NYSDEC AIR FACILITY REGISTRATION APPLICATION for Dry Cleaners using Perchloroethylene
and/or Approved Alternative Solvents
DEC ID #
Taxpayer ID #
1. Owner’s Name:
2. Owner’s Mailing Street Address:
3. City / Town:
4. State or Province:
5. Country:
6. ZIP/Postal Code:
7. Facility Owner/Manager (O/M) Name:
8. O/M Certification No. (Perc Only):
9a. Phone No.:
9b. Fax No.:
9c. email Address:
(
)
(
)
10. Facility Name:
11. Location Address:
12. City / Town:
13. State:
14. ZIP Code:
New York
15. Building Information:
❑ Vapor Barrier Installed
❑ General Exhaust Ventilation System Installed
a. Control Systems (check all that apply):
❑ Stand-Alone (No other building occupants)
❑ Co-located (Other building occupants)
b. Building Type (check one):
❑ Residences
❑ Senior Center
❑ Medical Office
❑ Exercise/Gym/Dance Studio
❑ Coin Laundromat
c. Co-located: check all boxes to
❑ Day Care/Pre-School
❑ School
❑ Retail Store
❑ Restaurant/Food Service
❑ Other Business
describe other types of tenants;
DRY CLEANING MACHINES (
Use additional form(s) to describe more than 3 machines)
Capacity
Year
Date
Solvent
Solvent
Spill Pan
Machine
Machine Manufacturer
Model Number
Serial Number
1
2
lbs.
Mfd.
Installed
Type
Gal/Yr*
(Y/N)
Type
16a.
17a.
18a.
19a.
20a.
21a.
22a.
23a.
24a.
25a.
/
/
16b.
17b.
18b.
19b.
20b.
21b.
22b.
23b.
24b.
25b.
/
/
16c.
17c.
18c.
19c.
20c.
21c.
22c.
23c.
24c.
25c.
/
/
1
Name all primary dry cleaning solvents given a
26. Other Solvent(s):
Solvent Type “Z” in Box 22a, 22b, or 22c.
2
Describe all dry cleaning machines given a
27. Other Machine(s):
Machine Type “Z” in Box 25a, 25b, or 25c.
CERTIFICATION: I certify that this facility will be operated in conformance with all provisions of existing regulations.
Responsible Official:
Title:
Signature:
Date:
*Refer to instructions for special guidance.
Form AFR-232 (5-07-2018)
NYSDEC Regional Offices
NYSDEC - Region 1
NYSDEC - Region 2
NYSDEC - Region 3
Attn: RAPCE
Attn: RAPCE
Attn: RAPCE
SUNY Stony Brook, Building 40
1 Hunters Point Plaza
21 South Putt Corners Road
50 Circle Road
47-40 21st Street
New Paltz, NY 12561-1696
Stony Brook, NY 11790-3409
Long Island City, NY 11101-5407
(845) 256-3045
(631) 444-0203
(718) 482-4900
Counties: Nassau & Suffolk
Counties: Bronx, Kings
Counties: Dutchess, Orange,
(Brooklyn), Manhattan, Queens,
Putnam, Rockland, Sullivan,
Richmond (Staten Island)
Ulster, Westchester
NYSDEC - Region 4
NYSDEC - Region 5 SUB-OFFICE
NYSDEC - Region 6
Attn: RAPCE
Attn: RAPCE
Attn: RAPCE
1130 North Westcott Road
232 Golf Course Road
State Office Building
Schenectady, NY 12306-2014
Warrensburg, NY 12885-1145
317 Washington Street
(518) 357-2045
(518) 623-1200
Watertown, NY 13601-3787
(315) 785-2239
Counties: Albany, Columbia,
Counties: Clinton, Essex,
Delaware, Greene, Montgomery,
Franklin, Fulton, Hamilton,
Counties: Herkimer, Jefferson,
Otsego, Rensselaer, Schoharie,
Saratoga, Warren, Washington
Lewis, Oneida, St. Lawrence
Schenectady
NYSDEC - Region 7
NYSDEC - Region 8
NYSDEC - Region 9
Attn: RAPCE
Attn: RAPCE
Attn: RAPCE
615 Erie Blvd., West
6274 E. Avon-Lima Road
270 Michigan Avenue
Syracuse, NY 13204-2400
Avon, NY 14414-9519
Buffalo, NY 14203-2999
(315) 426-7400
(585) 226-2466
(716) 851-7200
Counties: Broome, Cayuga,
Counties: Chemung, Genesee,
Counties: Allegany, Cattaraugus,
Chenango, Cortland, Madison,
Livingston, Monroe, Ontario,
Chautauqua, Erie, Niagara,
Onondaga, Oswego, Tioga,
Orleans, Schuyler, Seneca,
Wyoming
Tompkins
Steuben, Wayne, Yates
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