Environmental Permits Handbook

Air Permit Application Forms

Non-Title 5 Permit Application Forms

Title 5 Permit Application Forms

Application for Certification of Pollution Control Equipment for Property Tax or Sales Tax

Non-Title V Application Forms
Form Description	Form # (APC #)	Application Form		Form Instructions
Form Description	Form # (APC #)	DOC	PDF	DOC	PDF
Permit Application Form	#CN-0730 (APC 20)
Emission Point Description Form	#CN-0742 (APC 22)
Process Or Fuel Burning Source Description Form	#CN-0741 (APC 21 & 24)
Incinerator Source Description Form	#CN-0743 (APC 25)
Storage Tank Description Form	#CN-0744 (APC 27)
Degreaser Description Form	#CN-0745 (APC 29)
Oven Source Description Form	#CN-0746 (APC 30)
Surface Coating Description Form	#CN-0747 (APC 31)
Asphalt Plant Source Description Form	#CN-0748 (APC 33)
Rock Crushing Source Description Form	#CN-0735 (APC 43)
Dry Cleaner Source Description Form	#CN-1277 (APC 45)
Concrete Batch Plant Source Description Form	#CN-0749 (APC 122)
Coal Preparation Source Description Form	#CN-0750 (APC 123)
Cyclone Description Form	#CN-0751 (APC 129)
Stage I and Stage II Vapor Recovery	#CN-1001 (APC 150)
Asbestos Notification	#CN-1055	N/A		N/A	N/A
Asbestos Waste Shipment Record	#CN-1054	N/A		N/A	N/A

Title V Application Forms
Form Description	Form # (APC #)	Application Form		Form Instructions
Form Description	Form # (APC #)	DOC	PDF	DOC	PDF
Title V Index & Truth and Accuracy Statement	#CN-1007 (APC V.INDEX)			N/A	N/A
Facility Identification Form	#CN-1007 (APC V1)
Operations and Flow Diagrams	#CN-1007 (APC V2)
Stack Identification	#CN-1007 (APC V3)
Fuel Burning Non-Process Equipment	#CN-1007 (APC V4)
Stationary Gas Turbine or Internal Combustion Engine	#CN-1007 (APC V5)
Storage Tanks	#CN-1007 (APC V6)
Incineration	#CN-1007 (APC V7)
Printing Operations	#CN-1007 (APC V8)
Printing and Coating Operations	#CN-1007 (APC V9)
Miscellaneous Processes	#CN-1007 (APC V10)
Control Equipment - Miscellaneous	#CN-1007 (APC V11)
Control Equipment - Condensers	#CN-1007 (APC V12)
Control Equipment - Adsorbers	#CN-1007 (APC V13)
Control Equipment - Catalytic or Thermal Oxidation	#CN-1007 (APC V14)
Control Equipment - Cyclones / Settling Chambers	#CN-1007 (APC V15)
Control Equipment - Electrostatic Precipitator	#CN-1007 (APC V16)
Control Equipment - Wet Collection Systems	#CN-1007 (APC V17)
Control Equipment - Baghouses / Fabric Filters	#CN-1007 (APC V18)
Compliance Certification - Monitoring and Reporting Description of Methods Used for Determining Compliance	#CN-1007 (APC V19)
Compliance Demonstration by Continuous Emissions Monitoring	#CN-1007 (APC V20)
Compliance Demonstration by Portable Monitors	#CN-1007 (APC V21)
Compliance Demonstration by Monitoring Control System Parameters or Operating Parameters of a Process	#CN-1007 (APC V22)
Compliance Demonstration by Monitoring Maintenaince Procedures	#CN-1007 (APC V23)
Compliance Demonstration by Stack Testing	#CN-1007 (APC V24)
Compliance Demonstration by Fuel Sampling and Analysis	#CN-1007 (APC V25)
Compliance Demonstration by Recordkeeping	#CN-1007 (APC V26)
Compliance Demonstration by Other Method(s)	#CN-1007 (APC V27)
Emissions from Process Emission Source / Fuel Burning / INSTallation / Incinerator	#CN-1007 (APC V28)
Emission Summary for the Facility or for the Sources Contained in this Application	#CN-1007 (APC V29)
Current Emissions Requirements and Status	#CN-1007 (APC V30)
Compliance Plan and Compliance Certification	#CN-1007 (APC V31)
Major Source Air Monitoring Network	#CN-1007 (APC V32)			N/A	N/A
Stage I and Stage II Vapor Recovery	#CN-1007 (APC V33)
Open Burning	#CN-1007 (APC V34)			N/A	N/A
Application Completeness Check List	#CN-1007 (APC V35)			N/A	N/A

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