DAQ-2024-010167

Utah Division of Air Quality
New Source Review Section Company: _______________________
Site/Source: ______________________
Form 21 Date: ____________________________
Solvent Metal Cleaning (Degreasers)

Process Information
1. Operating schedule:

______ hrs/day

______ days/wk

______ weeks/year
2. Degreaser
Manufacturer:_________________
Model no.:____________________
Type:
□ Conveyorized □ Cold solvent
□ Open top vapor □ Batch
□ Other_______________________
3. Decription of metal parts or products
cleaned:
_______________________________
Average number of parts cleaned/hour:
_______________________________
Maximum number cleaned per hour:
_______________________________
4. Solvent usage:
Type: ____________________________
Gallons used during year: ____________
Vapor pressure: ______ (Psia @ 100 OF)
5. Solvent is: □ Sprayed □ Heated, temperature ____ OF
□ Agitated, by: □ Use of pump □ Compressed air
□ Vertical motion □ Ultrasonics
□ Other _______________________
6. Amount of solvent waste disposed of
throughout the year: _______ gallons
If known, solvent content in waste
___________________ % by volume
Method of disposal: ________________
________________________________
7. Freeboard:
a. Distance from solvent surface to top edge of degreaser
_______ inches
b. Width (not length) of tank at solvent surface _______ inches
c. Freeboard ratio, (a) above divided by (b) above
______________
8. Furnish manufacturer's Material Safety Data Sheets for all chemicals used in process.
Cold Cleaner Information
9. Equipped with cover: □ yes □ no
Easily operated with
one hand? □ yes □ no
10. Tank dimensions: Length: ________
Width: ________ Height: ________
Tank capacity: ______ gals of solvent
11. Method of draining parts:
____________________
____________________
12. Cold Cleaner has: □ Water cover □ Refrigerated chiller, operating temperature: _______ OF
□ Carbon adsorption □ Other control system: ____________________________________
□ None of the above
13. Ventilation: □ Carbon adsorption system (submit form 5)
□ None □ Other (describe) ______________________________________________

Page 1 of 3

Page 2 of 3
Form 21 – Solvent Metal Cleaning (Degreasers)
(Continued)

Open Top Vapor Degreaser and Conveyorized Degreaser Information
14. Dimensions of top opening:

Length: ______________

Width: _______________

15. Cover: □ yes □ no
Powered: □ yes □ no
Fixed spray
nozzles: □ yes □ no

16. Safety switches:

□ Condenser flow switch and thermostat which shuts off the sump heat if the
condenser coolant is either not circulating or too warm.
□ Device, other than a condenser flow switch and thermostat, which shuts off the
sump heat if the condenser coolant is either not circulating or too warm
(describe):_____________________________________________________
□ Spray safety switch which shuts off the spray pump if the vapor level drops
below any fixed spray nozzle.
□ Vapor level control thermostat which shuts off the sump heat when the vapor
level rises too high.
□ Device, other than a vapor level control thermostat, which shuts off the sump
heat when the vapor level rises too high
(describe):_____________________________________________________
______________________________________________________________
□ None of the above.

17. Indicate the type of pollution controls that open top vapor degreaser has (carbon filter, condenser, etc.):
_________________________________________________________________________________________
Conveyorized Degreaser Information
18. Type of degreaser system:
□ Cold □ Vapor
19. Operating temperature of solvent?
______________
20. Downtime covers:
□ yes □ no
21. Air/vapor interface is: ____________________sq. ft. (attach calculations )
22. Degreaser Controls:
□ Refrigerated freeboard
chiller.
□ Refrigerated condenser
coils.
□ Carbon adsorption.
□ Other control system
excluding condenser coils
and freeboard water
jacket, which reduces
solvent emission
(describe system and %
control efficiency).
□ None of the above.

23. Safety Switches:
□ Condenser flow switch and thermostat which shuts off the sump heat if the
condenser coolant is either not circulating or too warm.
□ Device, other than a condenser flow switch and thermostat, which shuts
off the sump heat if the condenser coolant is either not circulating or too
warm
(describe):________________________________________________
□ Spray safety switch which shuts off the spray pump if the vapor level drops
below any fixed spray nozzle.
□ Vapor level control thermostat which shuts off the sump heat when the
vapor level rises too high.
□ Device, other than a vapor level control thermostat, which shuts off the
sump heat when the vapor level rises too high (describe):
_________________________________________________________
_________________________________________________________
□ None of the above.
24. Conveyorized degreaser is equipped with the following equipment for preventing cleaned parts from carrying out
solvent liquid or vapor: □ None □ Drying tunnel □ Rotating basket □ Other

Page 3 of 3
Form 21 – Solvent Metal Cleaning (Degreasers)
(Continued)

Emissions Calculations (PTE)
25. Calculated emissions for each tank
VOC _________Lbs/hr_____ Tons/yr
HAPs_________Lbs/hr (speciate)______Tons/yr (speciate)
Specify the method of calculations. Also, provide manufacture’s Material Safety Data Sheets (MSDS) for
products being used. Submit calculations as an appendix.

Instructions

NOTE: 1. Submit this form in conjunction with Form 1 and Form 2.
2. Call the Division of Air Quality (DAQ) at [phone] if you have problems or questions in filling out
this form. Ask to speak with a New Source Review engineer. We will be glad to help!

1. Indicate the operating schedule of the degreaser.
2. Indicate the manufacturer, model number, serial number and type of degreaser.
3. Indicate the type of parts that will be cleaned in the degreaser (attach details) and the average and maximum
number of parts cleaner per hour.
4. Indicate the type, quantity, and vapor pressure of the solvent used in the degreaser.
5. Indicate whether the solvent is sprayed, heated, agitated, and to what temperature. Indicate if and how solvent is
agitated.
6. Indicate the amount and way waste solvent is disposed.
7. Indicate the calculations for freebroad ratio.
8. Supply the manufacturer’s material safety data sheets of any chemicals used with this application.
9. Indicate whether the degreaser is covered and if that cover is easily operated with one hand.
10. Supply the tank dimensions and capacity.
11. Describe the method of draining the degreased parts.
12. Indicate if any type of controls is used with the system and what they are.
13. Describe the carbon adsorption system if applicable.
14. Give dimensions of top opening.
15. Indicate if degreaser is equipped with cover and spray nozzles.
16. Indicate the types of safety switches used on the degreaser.
17. Indicate the type of controls used on the open top vapor degreaser.
18. Tell whether the degreaser uses a cold or a vapor system.
19. Give the operating temperature of the solvent.
20. Indicate whether the conveyorized degreaser has downtime covers.
21. Provide calculations showing the air/vapor interface. This is estimated using the dimensions of the open portion of
the tank at the condenser level.
22. Indicate the degreaser controls.
23. Indicate the types of safety switches used on the degreaser.
24. Indicate the type of equipment used to prevent carry out emissions.
25. Supply calculations for all criteria pollutants and HAPs (speciate, please). Use AP-42 or manufacturers’ data to
complete your calculations.

f:\aq\ENGINEER\GENERIC\Forms 2010\Form21 Degreasers.doc
Revised 12/20/10