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Mecklenburg County Recently Issued Title V Permits
Do I Need An Air Quality Permit?
Industrial, Commercial and Institutional Boilers (GACT 6J)
Spring Workshops
Area Source GACT Review 4Z 6J
Breakout Title V Green House Gasses
Transportation Facility Permitting
Pay Air Quality Fees
Annual Air Quality Forum
Gasoline Dispensing Facility Annual Report

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 Rev04/2011 PDF
Word

Section A -Facility Information

Form
A-1
Facility (General Information) Rev02/2013 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) Rev04/2011 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) Rev03/2005 PDF
Word
Form
C-2
Control Device (Fabric Filter) Rev03/2005 PDF
Word
Form
C-3
Control Device (Electrostatic Precipitator) Rev 03/2005 PDF
Word
Form
C-4
Control Device (Thermal or Catalytic Incinerator) Rev 03/2005 PDF
Word
Form
C-5
Control Device (Cyclone/Multicyclone) Rev 03/2005 PDF
Word
Form
C-6
Control Device (Absorber)
Rev 03/2005 PDF
Word
Form
C-7
Control Device (Scrubber) Rev 03/2005 PDF
Word
Form
C-8
Control Device (Condenser)
Rev 03/2005 PDF
Word
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Section D - Emission Estimations
Form
D-1-1
Master List of Materials Used Rev03/2005 PDF
Word
Form
D-1-3
Determination of Pounds VOC
per Gallon Solids (MCAPCO 2.0900)
Rev04/2011 PDF
Word
Form
D-1-4
Total VOC Emissions Calculations
(Mass Balance Method)
Rev 03/2005 PDF
Word
Form
D-1-5
Toxic/Haz Air Pollutant Emission Calculations (Mass Balance Method) Rev 01/2008 PDF
Word
Form
D-2-1
Emission Calculations by Methods other than Mass Balance as Calculated on
Forms D1-4 and D1-5
Rev03/2005 PDF
Word
Form
D-2-2
Summary of Emissions from D2-1 forms (Methods other than Mass Balance) Rev 03/2005 PDF
Word
Form
D-3-1
Facility-Wide Summary of Criteria Pollutants and HAP Emissions Rev 03/2005 PDF
Word
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Section E - Title V Special Forms
Form
E-1
Title V Information Rev 03/2005 PDF
Word
Form
E-2
Compliance Plan (Method of Compliance) Rev 03/2005 PDF
Word
Form
E-3
Title V Compliance Certification Rev 03/2005 PDF
Word
Form
E-4
Compliance Schedule Rev 03/2005 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 Rev 03/2005 PDF
Word
Form
M-4
Toxic Air Pollutant Off-Site Concentrations Rev 03/2005 PDF
Word
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SectionR - Dry Cleaners
Dry Cleaner Registration
Form
Rev 03/2005

PDF
Word

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

Form
S-1

General Information

Rev01/2013

PDF
Word

Form S-2

Stage I and Stage II

Rev 06/2011

PDF
Word

Form S-3

Facility Name and/or Legal Ownership Change

Rev 06/2011

PDF
Word

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Section T - Complex (Transportation) Sources
Form
T-1
Facility (General Information) Rev04/2011 PDF
Word
Form
T-2
Technical Information Rev04/2011 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

ZoningDetermination Process

Rev 12/2010

PDF
Word

Application for Tax Certification & Exemption

Rev 01/2008

PDF
Word

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Notifications

NESHAP Notification of Demolition and/or Renovation Rev 04/2009 PDF
Word
Performance Test Notification (Stack Testing) Rev05/2009 PDF
Word
VE Performance Test Notification Only Rev 05/2009 PDF
Word

NSPS Subpart Dc Construction/Operation
ofBoiler Notification

Rev 08/2009 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

Rev 08/2001

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 NSPSDc

Rev02/2009

PDF
Word

Annual Particulate Emission Report

 

Rev 04/2011

PDF
Word

Stage I/II Annual Gasoline Dispensing Report

Rev 01/2014

PDF
Word

Annual Fuel Usage Reporting Form

Rev 04/2011

PDF
Word

Tank Wash Reporting Form

Rev 07/2007

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 Rev 12/2006

PDF
Word

Visible Emission Observation Form (Method 9) Rev 02/2011 PDF

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