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All forms are available in MS Word or PDF file. Click here to download Adobe Acrobat Reader needed to view PDF files.

 
Permit Application Forms

General Instructions for completing any of the following applications Rev 04/2011  PDF
Word

Section A - Facility Information
Form
A-1
Facility (General Information) Rev 04/2011 PDF
Word
Form
A-2 
Notification/Change Form Rev 04/2011 PDF
Word
Form
A-3
Emission Source Changes Requested Rev 04/2011 PDF
Word 
Form
A-4
Facility-Wide Emission Source Listing Rev 04/2011 PDF
Word
Form
A-5
Facility-Wide Insignificant Activity Listing Rev 04/2011 PDF
Word
Form
A-6
Air Pollution Reduction/Recycling Activities Rev 04/2011 PDF
Word

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Section B - Process Equipment
Form
B
Emission Source (Required For All Sources)  Rev 04/2011  PDF
Word
Form
B-1
Emission Source (General) Rev 04/2011 PDF
Word
Form
B-2
Emission Source (Fuel Combustion Source) Rev 04/2011 PDF
Word
Form
B-2g
Emission Source (Internal combustion Engine) Rev 04/2011 PDF
Word
Form
B-3
Emission Source (Incinerator) Rev 04/2011  PDF
Word
Form
B-4
Emission Source (Coating/Finishing/Printing) Rev 04/2011 PDF
Word
Form
B-5
Emission Source (Manufacture of Chemicals/Coatings/Ink) Rev 04/2011  PDF
Word
Form
B-6 
Emission Source (Storage/Silos/Bins) Rev 04/2011  PDF
Word
Form
B-7 
Emission Source (Liquid Storage Tanks) Rev 04/2011  PDF
Word

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Section C - Control Equipment
Form
C-1
Control Device (General) PDF
Word
Form
C-2
Control Device (Fabric Filter) PDF
Word
Form
C-3
Control Device (Electrostatic Precipitator) PDF
Word
Form
C-4
Control Device (Thermal or Catalytic Incinerator) PDF
Word
Form
C-5 
Control Device (Cyclone/Multicyclone) PDF
Word
Form
C-6 
Control Device (Absorber)
PDF
Word
Form
C-7
Control Device (Scrubber) PDF
Word
Form
C-8
Control Device (Condenser)
PDF
Word

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Section D - Emission Estimations
Form 
D-1-1
Master List of Materials Used PDF
Word
Form
D-1-3
Determination of Pounds VOC per Gallon Solids (MCAPCO 2.0900) Rev   04/2011  PDF
Word
Form
D-1-4
Total VOC Emissions Calculations (Mass Balance Method) PDF
Word
Form
D-1-5
Toxic/Haz Air Pollutant Emission Calculations (Mass Balance Method) PDF
Word
Form
D-2-1
Emission Calculations by Methods other than Mass Balance as Calculated on Forms D1-4 and D1-5 PDF
Word
Form
D-2-2
Summary of Emissions from D2-1 forms (Methods other than Mass Balance) PDF
Word
Form
D-3-1
Facility-Wide Summary of Criteria Pollutants and HAP Emissions PDF
Word

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Section E - Title V Special Forms
Form
E-1
Title V Information PDF
Word
Form
E-2
Compliance Plan (Method of Compliance)   PDF
Word
Form
E-3
Title V Compliance Certification PDF
Word
Form
E-4
Compliance Schedule PDF
Word

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Section M - Dispersion Modeling Protocol/Report Forms
Form  
M-1
Screening Model Parameters Rev 06/2011 PDF
Word
Form
M-2
 Source Parameters Rev 06/2011 PDF
Word
Form
M-3
Toxic Air Pollutant Emission Rates   PDF
Word
Form
M-4
Toxic Air Pollutant Off-Site Concentrations   PDF
Word

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Section R - Dry Cleaners
Dry Cleaner Registration Form                     

PDF
Word

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Section S - Stage I/II (Strictly Gasoline Dispensing Operations) Sources

Form
S-1

General Information                       

PDF
Word

Form S-2

Stage I and Stage II 

PDF
Word

Form S-3

Facility Name and/or Legal Ownership Change

PDF
Word

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Section T - Complex (Transportation) Sources
Form
T-1
Facility (General Information)                          Rev 04/2011 PDF
Word
Form
T-2
Technical Information Rev 04/2011 PDF
Word

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Miscellaneous Application Forms

Appendix A - Completeness  Checklist            


Rev 04/2011

PDF
Word

Appendix  B - Regulated Air Pollutants

Rev 04/2011

PDF
Word

Zoning Determination Process  

 

PDF
Word

Application for Tax Certification & Exemption

 

PDF
Word


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Notifications

NESHAP Notification of Demolition and/or Renovation  PDF
Word
Performance Test Notification (Stack Testing) PDF
Word
VE Performance Test Notification Only PDF
Word

NSPS Subpart Dc Construction/Operation
of Boiler Notification

PDF
Word

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  Reporting Forms

Title V Annual Compliance Certification Form  Rev 04/2011  PDF
Word
Title V 6-Month Monitoring Report PDF
Annual VOC Reporting Form Rev 04/2011 PDF
Word
Quarterly VOC Reporting Form Rev 04/2011  PDF
Word
Semi-Annual Reporting Form for Boilers Under NSPS Subpart Dc PDF
Word
Annual Particulate Emission Report Rev 04/2011  PDF
Word
Stage I/II Annual Gasoline Dispensing Report PDF
Word
Annual Fuel Usage Reporting Form Rev  04/2011  PDF
Word
Tank Wash Reporting Form PDF
Word
Annual Emission Report Form Rev 04/2011

PDF
Word


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Monitoring/Recordkeeping Forms

Chrome Electroplating Tank Monitoring Form Rev 04/2011 PDF
Word
Industrial Nuisance Odors Citizen's Log

PDF 
Word

Visible Emission Observation Form (Method 9) PDF

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