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Mecklenburg County > Air Quality > Permitting Regulations > Forms

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 02/2013	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)	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)	Rev 03/2005	PDF Word
Form C-2	Control Device (Fabric Filter)	Rev 03/2005	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	Rev 03/2005	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)	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	Rev 03/2005	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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Section R - Dry Cleaners

Dry Cleaner Registration
Form

Rev 03/2005

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

Form S-1	General Information	Rev 01/2013	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)	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	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)	Rev 05/2009	PDF Word
VE Performance Test Notification Only	Rev 05/2009	PDF Word
NSPS Subpart Dc Construction/Operation of Boiler Notification	Rev 08/2009	PDF Word

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Reporting Forms

Title V Annual Compliance Certification Form Rev 04/2011		Rev 04/2011	PDF Word
Title V 6-Month Monitoring Report		Rev 08/2001	PDF
Annual VOC Reporting Form Rev 04/2011		Rev 04/2011	PDF Word
Quarterly VOC Reporting Form Rev 04/2011		Rev 04/2011	PDF Word
Semi-Annual Reporting Form for Boilers Under NSPS Dc		Rev 02/2009	PDF Word
Annual Particulate Emission Report Rev 04/2011		Rev 04/2011	PDF Word
Stage I/II Annual Gasoline Dispensing Report		Rev 01/2008	PDF Word
Annual Fuel Usage Reporting Form Rev 04/2011		Rev 04/2011	PDF Word
Tank Wash Reporting Form		Rev 07/2007	PDF Word
Annual Emission Report Form Rev 04/2011		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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