​​​​​​​​Air Quality Permitting and Enforcement Forms

Section A - Facility Information

Form A-1

Facility (General Information)

Rev 03/2018

PDF or Word

Form A-2

Notification/Change Form

Rev 04/2011

PDF or Word

Form A-3

Emission Source Changes Requested

Rev 04/2011

PDF  or Word

Form A-4

Facility-Wide Emission Source Listing

Rev 04/2011

PDF or Word

Form A-5

Facility-Wide Insignificant Activity Listing

Rev 04/2011

PDF or Word

Section B - Process Equipment

Form B

Emission Source (Required For All Sources)

Rev 04/2011

PDF or Word

Form B-1

Emission Source (General)

Rev 04/2011

PDF or Word

Form B-2

Emission Source (Fuel Combustion Source)

Rev 04/2011

PDF or Word

Form B-2g

Emission Source (Internal combustion Engine)

Rev 04/2011

PDF or Word

Form B-3

Emission Source (Incinerator)

Rev 04/2011

PDF or Word

Form B-4

Emission Source (Coating/Finishing/Printing)

Rev 04/2011

PDF or Word

Form B-5

Emission Source (Manufacture of Chemicals/Coatings/Ink)

Rev 04/2011

PDF or Word

Form B-6

Emission Source (Storage/Silos/Bins)

Rev 04/2011

PDF or Word

Form B-7

Emission Source (Liquid Storage Tanks)

Rev 04/2011

PDF or Word

Section C - Control Equipment

Form C-1

Control Device (General)

Rev 03/2005

PDF or Word

Form C-2

Control Device (Fabric Filter)

Rev 03/2005

PDF or Word

Form C-3

Control Device (Electrostatic Precipitator)

Rev 03/2005

PDF or Word

Form C-4

Control Device (Thermal or Catalytic Incinerator)

Rev 03/2005

PDF or Word

Form C-5

Control Device (Cyclone/Multicyclone)

Rev 03/2005

PDF or Word

Form C-6

Control Device (Adsorber)

Rev 03/2005

PDF or Word

Form C-7

Control Device (Scrubber)

Rev 03/2005

PDF or Word

Form C-8

Control Device (Condenser)

Rev 03/2005

PDF or Word

Section D - Emission ​Estimations​​

Form D-1-1

Master List of Materials Used

Rev 03/2005

PDF or Word

Form D-1-3

Determination of Pounds VOC per Gallon Solids (MCAPCO 2.0900)

Rev 04/2011

PDF or Word

Form D-1-4

Total VOC Emissions Calculations (Mass Balance Method)

Rev 03/2005

PDF or Word

Form D-1-5

Toxic/Haz Air Pollutant Emission Calculations (Mass Balance Method)

Rev 01/2008

PDF or 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 or Word

Form D-2-2

Summary of Emissions from D2-1 forms
(Methods other than Mass Balance)

Rev 03/2005

PDF or Word

Form D-3-1

Facility-Wide Summary of Criteria Pollutants and HAP Emissions

Rev 03/2005

PDF or Word

Section E - Special Title V Forms

Form E-1

Title V Information

Rev 03/2005

PDF or Word

Form E-2

Compliance Plan (Method of Compliance)

Rev 03/2005

PDF or Word

Form E-3

Title V Compliance Certification

Rev 03/2005

PDF or Word

Form E-4

Compliance Schedule

Rev 03/2005

PDF or Word

Section M - Dispersion Modeling

Form M-1

Screening Model Parameters

Rev 08/2018

PDF or Word

Form M-2

Source Parameters

Rev 06/2011

PDF or Word

Form M-3

Toxic Air Pollutant Emission Rates

Rev 03/2005

PDF or Word

Form M-4

Toxic Air Pollutant Off-Site Concentrations

Rev 03/2005

PDF or Word

​​Section R - Dry Cleaners

Dry Cleaner Registration Form

Rev 03/2005

PDF or Word

Section S - Stage I/II (Gasoline Dispensing)

Form S-1

General Information

Rev 01/2013

PDF or Word

Form S-2

Stage I and Stage II

Rev 06/2011

PDF or Word

Form S-3

Facility Name and/or Legal Ownership Change

Rev 06/2011

PDF or Word

Section 6H – Paint Stripping & Surface Coating

Form A1-6H

General Information

Rev 04/2018

PDF or Word

Form B4-6H

Emission Source (Misc. Surface Coating/Autobody Refinishing)

Rev 04/2018

PDF or Word

Form D-1-6H

VOC Actual Emissions (Mass Balance Method)

Rev 04/2018

PDF or Excel

Form D-1-6H

Instructions

Rev 04/2018

PDF

Miscellaneous Application Forms

Appendix A - Completeness Checklist

Rev 09/2014

PDF or Word

Appendix B - Regulated Air Pollutants

Rev 04/2011

PDF or Word

Zoning Determination Process

Rev 09/2014

PDF or Word

Application for Tax Certification & Exemption

Rev 10/2016

PDF or Word

Notification Forms

NESHAP Notification of Demolition and/or Renovation

Rev 04/2009

PDF or Word

Performance Test Notification (Stack Testing)

Rev 05/2009

PDF or Word

VE Performance Test Notification Only

Rev 05/2009

PDF or Word

NSPS Subpart Dc Construction/Operation
of Boiler Notification

Rev 08/2009

PDF or Word

Quarry Construction/Operation Change Notification

Rev 08/2007

PDF

Reporting Forms

Title V Annual Compliance Certification Form

Rev 04/2011

PDF or Word

Title V 6-Month Monitoring Report

Rev 08/2001

PDF or Word 

Annual VOC Reporting Form

Rev 04/2011

PDF or Word

Quarterly VOC Reporting Form

Rev 04/2011

PDF or Word

Semi-Annual Reporting Form for Boilers Under NSPSDc

Rev02/2009

PDF or Word

Annual Particulate Emission Report

Rev 04/2011

PDF or Word

Annual Fuel Usage Reporting Form

Rev 04/2011

PDF or Word

Tank Wash Reporting Form

Rev 07/2007

PDF or Word

Annual Emission Report Form

Rev 04/2011

PDF or Word

Monitoring/Recordkeeping Forms

Chrome Electroplating Tank Monitoring Form

Rev 04/2011

PDF or Word

Industrial Objectionable Odors Citizen's Log

Rev 08/2018

PDF or Word

NSPS Subpart OOO Inspection Log

Rev 04/2015

PDF

Visible Emission Observation Form (Method 9)

Rev 02/2011

PDF

Baghouse-Filter Monitoring Logs

Daily Pressure Drop with Temperature

Rev 12/2016

Excel

Daily Pressure Drop without Temperature

Rev 12/2016

Excel

Monthly Pressure Drop with Temperature

Rev 12/2016

Excel

Monthly Pressure Drop without Temperature

Rev 12/2016​

Excel

Scrubber Monitoring Logs

Scrubber Daily with pH

Rev 12/2016

Excel

Scrubber Daily without pH

Rev 12/2016

Excel

Scrubber Weekly with pH

Rev 12/2016

Excel

Scrubber Weekly without pH

Rev 12/2016

Excel

Scrubber Monthly with pH

Rev 12/2016

Excel

Scrubber Monthly without pH

Rev 12/2016

Excel

Stage I (Gasoline Dispensing) Reporting and Notification Forms

Annual Gasoline Dispensing Report

Rev 01/2014

PDF or Word

Stage I Performance Test Notification Form

Rev 01/2016

PDF or Word

Stage I Operation and Compliance Status Form

Rev 01/2016

Word

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