Permit Application Forms

The following forms are in PDF format and are fillable with current or earlier versions of Adobe Acrobat Reader.  However, to save a copy of the completed forms, you will need a full version of Adobe Acrobat 7.0 or later. 


Many of the forms are continually updated.  
Please use the current forms below for your submittals.

 

To determine if your equipment needs a permit or is subject to a filing requirement:

  1. Check SCAQMD Rule 219 to determine if the equipment is exempt from requiring a permit. 
  2. If the equipment is exempt as per Rule 219, check Rule 222 to determine if the equipment is subject to filing requirements.
  3. If your equipment is subject to filing requirements, see Rule 222 Filing Program for more information on filing.

To apply for a permit:

  1. Submit Form 400AForm 400-CEQAForm 400-PS and a supplemental Form 400-E-xx (for certain equipment type) for each equipment along with applicable fees (Fee Calculator).  See Common Operations and Equipment for a list of equipment with respective forms and contact information. 

If you need assistance with filing an application, see the Permitting Staff Locator  for a directory of contacts for your particular equipment or business type or call Permit Services at 909-396-3385. 

Administrative Forms
  • Name Change
  • Mailing Address Change
  • Inactivate Permit
  • Reinstate Permit
  • Change of Operator
  • Additional Operator
ERC Form

Emission Reduction Credit - Certificate of Title

Other Forms

Other forms not directly used for permitting
Basic Forms for Permits and Plans

To be submitted with all applications for permits and plans (except registered equipment). IncludeSupplemental Application Forms (Forms 400-E-xx)with the appropriate fees when applying for a Permit to Operate.
Supplemental Application Forms (400-E-XX)

Equipment specific forms to be included with Basic Forms when applying for a Permit to Operate.

RECLAIM Forms

For RECLAIM and RECLAIM/Title V facilities.
Title V Forms

Title V application and reporting forms.

ADMINISTRATIVE FORMS
Form Title Size
200-A Business Name Change Notification
Name change only. Not for Change of Operator/Owner.
245kb
200-B Mailing Address Update/Correction
Mailing address change only. Not for change of equipment location.
939kb
200-C Request to Inactivate a Permit to Operate
For equipment that has been removed or shut down.
277kb
200-D Request to Reinstate Expired Application or Permit to Operate
For reactivating expired applications and permits. Back fees and reinstatement fees may apply.
1.15MB
400-AO Application for Additional Operator
For a permit to be issued to an additional operator.
326kb
400-CO Application for Change of Operator
For sale of a business, change of ownership, or change in the equipment operator. Fees required.
909kb
Administrative Package Zip file of all forms listed above and SCAQMD Form 401. 4.3MB

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ERC FORM
Form Title Size
401 Application for Emission Reduction Credit (ERC) Certificate of Title
For new ERC and change or modifications to ERC. (2013.07)
944kb
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OTHER FORMS
Form Title Size
AB3205 AB3205 School Site Grid Search Request form.
Pursuant to California education code 17213, this request is for the identification of all SCAQMD permitted facilities with the potential to emit hazardous air pollutants located within 1/4 mile of a school site.
173kb
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BASIC FORMS FOR PERMITS AND PLANS

Form Title Size
400-A Application Form for Permit or Plan Approval 324kb
Form 400-A Instructions 94kb
400-CEQA California Environmental Quality Act (CEQA) Applicability 326kb
Form 400-CEQA Instructions 46kb
CEQA Table 1-Q7 48kb
CEQA Notice of Exemption Notice of Exemption [Letter to County] 148kb
400-PS Plot Plan and Stack Information Form 472kb
400-XPP Express Permit Processing Request 253kb
Application Checklist 380kb
Fee Calculation Worksheet
Basic Package Zip file of all forms listed above 1.7MB

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SUPPLEMENTAL APPLICATION FORMS (400-E-XX)


These forms are to be submitted with the Basic Forms when applying for a permit. Choose a form below according to the type of equipment. If a specific equipment type form is not listed below, use 400-E-GI.
Form Title Size
400-E-GI General Information Summary
Use this form if a specific equipment form is not available below.
73kb
400-E-1a Particulate Matter Control Fabric Filter (Baghouse)/Cartridge Collector 653kb
400-E-1b Particulate Matter Control Cyclone Separator 426kb
400-E-1c Particulate Matter ControlElectrostatic Precipitator (ESP) 419kb
400-E-2a Gaseous Emission Control Form Afterburner/Oxidizer 438kb
400-E-2b Gaseous Emission Control Form Adsorber (Carbon, Others) 310kb
400-E-2c Gaseous Emission Control Form Flare 233kb
400-E-3 Scrubber 269kb
400-E-4a* Portable/Open Abrasive Blasting Equipment 354kb
400-E-4b* Abrasive Blasting Equipment (Other Than Portable/Open) 420kb
400-E-5 Selective Catalytic Reduction (SCR) System, Oxidation Catalyst and Ammonia Catalyst 379kb
400-E-7 Dry-Cleaning Equipment 313kb
400-E-8 Ethylene Oxide Sterilizer 310kb
400-E-9a* External Combustion Boiler/Heater 327kb
400-E-9b External Combustion Oven 318kb
400-E-9c External Combustion Solder Reflow/Wave/Hot Air Leveling Machine 316kb
400-E-9d External Combustion Burn Off Furnaces/Brake Debonders/Wax Burnoff Furnaces 326kb
400-E-9e External Combustion Food Broiler/Fryer 316kb
400-E-9f External Combustion Metal Melting & Heat Treating Furnaces 344kb
400-E-10 Degreaser 310kb
400-E-11* Fuel Dispensing and Storage Equipment 488kb
400-E-12 Gas Turbine 360kb
400-E-13a* Emergency Internal Combustion Engine 198kb
400-E-13b Non-Emergency Internal Combustion Engine 355kb
400-E-14 Open Process Tank 354kb
400-E-15 Printing Equipment 328kb
400-E-16 Storage Tank Solid Material 295kb
400-E-17a* Powder Coating Operation 360kb
400-E-17b Spray Booth/Open Spray 376kb
400-E-18 Storage Tank 414kb
400-E-19 Particulate Matter Control Asbestos and/or Lead Removal Equipment 282kb
400-E-20-Form Plasma Arc/Laser Cutter 534kb
400-E-21 Supplemental Permit Application for Dairy Farms 361kb
400-E-22 Supplemental Permit Application for Laying Hen Ranches 354kb
400-E-23 Supplemental Permit Application for Existing Agricultural Orchard Heaters 272kb
Supplemental Package Zip file of all forms listed above 12.3MB

* These forms are 'intelligent' forms which perform basic emissions calculations as you enter data.  The forms also show standard permit conditions for the equipment.  NOTE:  The actual permit conditions may differ upon thorough review of your application. 

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RECLAIM FORMS
Monitoring, Recordkeeping & Reporting Forms
Form Title Size
CERE Corrections to Electronically Reported Emissions 320kb
NOx/SOx-1 Monitoring, Reporting, and Recordkeeping (MRR) 417kb
NOx/SOx–2 Recordkeeping Form for Major and Large Sources 202kb
NOx/SOx–3 Recordkeeping Form for Process Units or Rule 219 Exempt Units with Fuel Meters 208kb
NOx/SOx–4 Recordkeeping Form for Process Units or Rule 219 Exempt Units with Timers 219kb
NOx/SOx–5 Recordkeeping Form for Non-Fuel Based Sources and Units 222kb
QCE-1 Corrections to Monthly Reported Emissions (Major and Large Sources)
And Quarterly Reported Emissions (Process Units and Equipment Exempt Under Rule 219)
452kb
QCER Quarterly Certification of Emissions Report 368kb
Trading Forms
2007-1 Representative Registration and Certification 752kb
Attachment A Designation of Agent for Service of Process and Consent to California Jurisdiction
To be used in conjunction with Form 2007-1 for entities not domiciled with the State of California and who are not RECLAIM Facility Permit holders.

Note: Attachment A includes requirement for a certification, contract or other documentation provided bythe designated Agent for Service of Process. Such documentation shall include:
A. The agent is a licensed Agent for Service of Process in the State of California,
B. The appointing entity (i.e. RTC trader), the start and end date of the appointment,

If the appointment is LESS THAN 4 years from the date of receipt, then:
C. Statement that the appointing entity has requested appointment of 4 or more years, and
D. Maximum term of appointment/contract that the Agent for Service of Process would accept (e.g. annual, bi-annual).
136kb
2007-2 RECLAIM Trading Credits (RTCs) Transaction Registration
Instructions and Examples for Form 2007-2(pdf 91kb)
268kb
2007-3 RECLAIM Trading Credits (RTCs) Owner Identification 392kb
2007-4A RECLAIM Trading Credits (RTCs) Report of Contingent Right to Purchase RTCs 194kb
2007-4B RECLAIM Trading Credits (RTCs) Report of Forward Contract 189kb
RECLAIM Package Zip file of all forms listed above 4.1MB


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Title V Forms
To determine which forms are necessary, refer to the TV-Application-Matrix (pdf 24.4kb).

Form Title Size
400-A Application Form for Permit or Plan Approval 363kb
Form 400-A Instructions 91kb
400-CEQA California Environmental Quality Act (CEQA) Applicability 367kb
Form 400-CEQA Instructions 67kb
CEQA Table 1-Q7 78kb
CEQA Notice of Exemption Notice of Exemption [Letter to County] 245kb
500-A1 Title V Permit Application Supplemental (NO LONGER USED)
500-A2 Title V Application Certification 382kb
500-ACC Report for Annual Compliance Certification 284kb
500-B List of Exempt Equipment 308kb
500-C1 Compliance Status Report This form is now a fill-in form. 157kb
500-C2 Non-Compliant Operations Report and Part 70 Compliance Schedule/Plan and Quality Improvement Plan - QIP 78kb
500-D Permit Shield Request 266kb
500-E Exclusion/Exemption Request 366kb
500-F1 Title IV - Acid Rain Phase II Facility Information Summary 398kb
500-F2 Title IV - Acid Rain Phase II Repowering Extension Plan 423kb
500-F3 Title IV - Acid Rain Phase II New Unit Exemption Request 62kb
500-F4 Title IV - Acid Rain Phase II Retired Unit Exemption Request 167kb
500-G Hearing Request 268kb
500-H Compliance Assurance Monitoring (CAM) Applicability Determination for Initial, Renewal & Significant Permit Revision 262kb
500-MACT MACT Part 1 Application 264kb
500-N Deviations, Emergencies & Breakdowns 333kb
500-RO Delegation of Responsible Official 265.6kb
500-SAM Semi-Annual Monitoring Report 388kb
Title V Package Zip file of all forms listed above 6.7MB


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