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Air Quality Division Forms

General Air Forms
Emissions Inventory Forms
Permitting Forms
Compliance/Enforcement Forms
Asbestos Form
Lead-Based Paint Forms
 
GENERAL AIR   Back to Top

#100-600

     NSPS Modification Form

MS Word PDF

     EXAMPLE: NSPS Modification Asphalt Plant

MS Word PDF

#100-221

     Zero Emissions Determination Forms

MS Word PDF

#100-950

     Notification of Open Burning for Fire Training

MS Word PDF
#100-222      Determination Request For Gasoline or Diesel Fuel Desulfurization Facilities MS Word PDF
 
EMISSIONS INVENTORY   Back to Top

#100-730

     Turn-Around Document and Instructions

Follow hyperlink to the left

#100-750

     Emissions Inventory Reporting Form for Dry Cleaners

MS Word PDF
#100-882      Designation of Responsible Official MS Word PDF
 
PERMITTING   Back to Top

     Administrative Forms

#100-815      Classification of AQ Permit Applications & Application Fees MS Word PDF

#100-821

     Tier 2 or 3 Application Notice of Filing Publication Requirements

MS Word PDF

#100-822

     Tier 2 or 3 Notice of Draft Permit Publication Requirements

MS Word PDF

#100-823

     Tier 3 Notice of Proposed Permit Publication Requirements

MS Word PDF

#100-810

     DEQ Landowner Notification Affidavit

MS Word PDF

#100-884

     General Facility Information

MS Word PDF
#100-883      Administrative Change Notification - Request for Transfer and
     Administrative Amendment of Permit
MS Word PDF
#100-882      Designation of Responsible Official MS Word PDF

#100-115

     Applicability Determination Application Guide

MS Word PDF

     Part 70 (Major) Source Forms   Back to Top

#100-003

     Title V Renewal Form

MS Word PDF

#100-001

     Title V Application  (zip file)

Follow hyperlink to the left

#100-011

     MACT Hammer Part 1 Application

MS Word PDF

#100-365

     Air Curtain Incinerator General Permit Application

MS Word PDF

     Minor Source Forms   Back to Top

#100-105

     Minor Facility Application Guide

MS Word PDF

#100-360

     Area Source NESHAP & Small NSPS Facilities General Permit Application

MS Word PDF
n/a Checklist for the Non-Title V Application MS Word PDF

#100-886

     Minor Source Relocation Application

MS Word PDF

#100-888

     Notice of Intent to Construct

MS Word PDF

#100-889

     Notice of Intent to Operate

MS Word PDF

#100-220

     Permit By Rule Registration Form

MS Word PDF

     Industry-Specific Forms   Back to Top

#100-340

     Hot Mix Asphalt Plants General Permit Application

MS Word PDF

     Oil & Gas Industry

#100-223      Permit By Rule Oil and Natural Gas Sector Application Forms MS Word PDF

#100-401

     40 CFR Part 63; Subparts HH & HHH Facility Registration Form

MS Word PDF

#100-100

     Natural Gas Compressor Station Application

MS Word PDF

#100-305

     Oil & Gas Facilities - Minor Source General Permit Application

MS Word PDF

     Halogenated Solvent Cleaning (notification forms for 40 CFR Part 63, Subpart T)

#100-431

     Initial Notification for New and Existing Halogenated Solvent Cleaning Machines

MS Word PDF

#100-433

     Initial Statement of Compliance for Batch Vapor or In-Line
     Halogenated Solvent Cleaning Machines (Equipment Standard)

MS Word PDF

#100-434

     Initial Statement of Compliance for Batch Vapor or In-Line
     Halogenated Solvent Cleaning Machines (Alternative Standard)

MS Word PDF

#100-432

     Compliance Report for New & Existing Batch Cold Halogenated
     Solvent Cleaning Machines

MS Word PDF

#100-436

     Annual Solvent Emissions Report for Batch Vapor or In-Line
     Halogenated Solvent Cleaning Machines (Alternative Standard)

MS Word PDF

#100-435

     Annual Report for Batch Vapor or In-Line Halogenated Solvent Cleaning Machines
     (Equipment Standard)

MS Word PDF

#100-437

     Exceedance Report Form for Batch Vapor or In-Line Halogenated Solvent Cleaning
     Machines

MS Word PDF

     Dry Cleaning Back to Top

#100-310

     Dry Cleaning Minor Facility General Permit Application

MS Word PDF

#100-311

     Dry Cleaning Facilities Registration Form

MS Word PDF

#100-310-G

     Perchloroethylene Consumption Log

MS Word PDF

#100-310-H

     Refrigerated Condenser Weekly Temperature Log

MS Word PDF

#100-310-J

     Leak Detection and Repair Log

MS Word PDF

#100-310-I

     Carbon Absorber Weekly Log

MS Word PDF

     Chromium Electroplating Back to Top

#100-320

     Chromium Electroplating and Anodizing Minor Facility General Permit Application
     (including halogenated solvent cleaning machines)

MS Word PDF

#100-420

     Chromium GP Optional Forms Packet

MS Word PDF

#100-422

     Initial Notification for New Chromium Electroplating and Anodizing Tanks

MS Word PDF

#100-423

     Initial Notification for Existing Chromium Electroplating and Anodizing Tanks

MS Word PDF

#100-421

     Notice of Construction/Reconstruction for Chromium Electroplating
     and Anodizing Tanks

MS Word PDF

#100-424

     Notification of Compliance Status for Chromium Electroplating and Anodizing Tanks

MS Word PDF

     Non-Metallic Mineral Processing Back to Top

#100-330

     Non-Metallic Mineral Processing Minor Facility General Permit Application

MS Word PDF

#100-110

     Rock Crushers & Sand & Gravel Application

MS Word PDF

     Printing, Packaging and Publishing  Back to Top

#100-350

     Printing/Packaging General Permit Application

MS Word PDF

#100-351

     Printing/Publishing Registration

MS Word PDF
 
COMPLIANCE/ENFORCEMENT   Back to Top

     Semiannual Fugitive emission Equipment Leak Report

#100-611

    Semiannual Fugitive Emission Equipment Leak Report Form

MS Word PDF

     Excess Emissions

#100-920     Excess Emission Reporting Form MS Word PDF

     Self-Reporting of Non-Compliance

#100-930

   Voluntary Disclosure / Self-Reporting of Noncompliance Form   

MS Word PDF

     Annual Compliance Certification and Semi-Annual Monitoring & Deviation Report Form  Please use the forms below to comply with Title V reporting requirements.

#100-924

     Annual Compliance Certification Form

MS Word PDF

#100-924A

     Annual Compliance Certification Form Instructions

MS Word PDF

#100-925

     Semi-Annual Monitoring & Deviation Report Form

MS Word PDF

#100-925A

     Semi-Annual Monitoring & Deviation Report Form Instructions

MS Word PDF
 
ASBESTOS   Back to Top

n/a

     Asbestos NESHAP Notification
     (requirements and notification form for building & renovation projects)

MS Word PDF
 
LEAD   Back to Top

#110-501

     Abatement Notification

MS Word PDF

#110-101

     Accreditation Application

MS Word PDF

#110-301

     Certification Application

MS Word PDF
       New Procedures (and Affidavit) for Obtaining Individual Licenses/Certifications PDF

#110-303

     Firm Application (not for RRP)

MS Word PDF

#110-304

     Government Affidavit (not for RRP)

MS Word PDF
#110-305

     Renovation, Repair & Painting Program (RRP) Firm Application

MS Word PDF

#110-102

     Instructor Application

MS Word PDF

#110-121

     Notification of Lead-Based Paint or Renovator Course

MS Word PDF
#110-122     Notification of Lead-Based Paint or Renovator Course Completion MS Word PDF

#110-302

    Retest Application

MS Word PDF

#110-502

    Quarterly Report Form (Inspector/Risk Assessor) - 2016/17

 

PDF

#110-502

    Quarterly Report Form (Inspector/Risk Assessor) - 2015/16

 

PDF

#110-503

    Quarterly Report Form (Project Designer/Supervisor/Abatement Worker) - 2016/17

 

PDF

#110-503

    Quarterly Report Form (Project Designer/Supervisor/Abatement Worker) - 2015/16

 

PDF

Last Updated: July 11, 2016