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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 PDF
Word

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

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Section B - Process Equipment

Form
B

Emission Source (Required For All Sources) 

PDF
Word

Form
B-1

Emission Source (General)

PDF
Word

Form
B-2

Emission Source (Fuel Combustion Source)

PDF
Word

Form
B-2g

Emission Source (Internal combustion Engine)

PDF
Word

Form
B-3

Emission Source (Incinerator)

PDF
Word

Form
B-4

Emission Source (Coating/Finishing/Printing)

PDF
Word

Form
B-5

Emission Source (Manufacture of Chemicals/Coatings/Ink)

PDF
Word

Form
B-6 

Emission Source (Storage/Silos/Bins)

PDF
Word

Form
B-7 

Emission Source (Liquid Storage Tanks)

PDF
Word

 

Emission Source Information (Excel Version)

XLS


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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)

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

 

Emission Estimations (Excel Version)

XLS



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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
Downwash/Model Parameters PDF
Word
Form
M-2A  
Area Source Parameters PDF
Word
Form
M-2P
Point Source Parameters PDF
Word
Form
M-2V  
Volume Source Parameters 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)                          PDF
Word
Form
T-2
Technical Information PDF
Word


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Miscellaneous Application Forms

Appendix A - Completeness Checklist                  

PDF
Word

Appendix  B - Regulated Air Pollutants

PDF
Word

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

PDF
Word


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Monitoring/Recordkeeping Forms

Chrome Electroplating Tank Monitoring Form PDF
Word
Industrial Nuisance Odors Citizen's Log

PDF 
Word

Visible Emission Observation Form (Method 9) PDF

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