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Permit Application Forms 

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 AQMD 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 400A, Form 400-CEQA, Form 400-PS and a supplemental Form 400-E-xx (for certain equipment type) for each equipment along with applicable fees.  See the 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).     Include Supplemental 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.
245 kb
200-B Mailing Address Update/Correction
Mailing address change only.  Not for change of equipment location.
939 kb
200-C Request to Inactivate a Permit to Operate
For equipment that has been removed or shut down.
277 kb
200-D Request to Reinstate Expired Application or Permit to Operate
For reactivating expired applications and permits.  Back fees and reinstatement fees may apply.
1.15 Mb
400-AO Application for Additional Operator
For a permit to be issued to an additional operator.
326 kb
400-CO Application for Change of Operator
For sale of a business, change of ownership, or change in the equipment operator.  Fees required.
909 kb
Form M Application for Architectural Manufacturer ID Number
For a paint manufacturer's ID number for  compliance with AQMD Rule 314.
101 kb
 Administrative Package  Zip file of all forms listed above and AQMD Form 401. 4.3 Mb

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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)
944 kb

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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 AQMD permitted facilities with the potential to emit hazardous air pollutants located within 1/4 mile of a school site.
173 kb

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

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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.
73 kb
400-E-1a Particulate Matter Control Fabric Filter (Baghouse)/Cartridge Collector 653 kb
400-E-1b Particulate Matter Control Cyclone Separator 426 kb
400-E-1c Particulate Matter Control Electrostatic Precipitator (ESP) 419 kb
400-E-2a Gaseous Emission Control Form Afterburner/Oxidizer 438 kb
400-E-2b Gaseous Emission Control Form Adsorber (Carbon, Others) 310 kb
400-E-2c Gaseous Emission Control Form Flare 233 kb
400-E-3 Scrubber 269 kb
400-E-4a* Portable/Open Abrasive Blasting Equipment 354 kb
400-E-4b* Abrasive Blasting Equipment (Other Than Portable/Open) 420 kb
400-E-5 Selective Catalytic Reduction (SCR) System, Oxidation Catalyst and Ammonia Catalyst 379 kb
400-E-7  Dry-Cleaning Equipment 313 kb
400-E-8 Ethylene Oxide Sterilizer 310 kb
400-E-9a* External Combustion Boiler/Heater 327 kb
400-E-9b External Combustion Oven 318 kb
400-E-9c External Combustion Solder Reflow/Wave/Hot Air Leveling Machine 316 kb
400-E-9d External Combustion Burn Off Furnaces/Brake Debonders/Wax Burnoff Furnaces 326 kb
400-E-9e External Combustion Food Broiler/Fryer 316 kb
400-E-9f External Combustion Metal Melting & Heat Treating Furnaces 344 kb
400-E-10 Degreaser 319 kb
400-E-11* Fuel Dispensing and Storage Equipment 488 kb
400-E-12 Gas Turbine 360 kb
400-E-13a* Emergency Internal Combustion Engine 198 kb
400-E-13b Non-Emergency Internal Combustion Engine 355 kb
400-E-14 Open Process Tank 354 kb
400-E-15 Printing Equipment 328 kb
400-E-16 Storage Tank Solid Material 295 kb
400-E-17a* Powder Coating Operation 360 kb
400-E-17b Spray Booth/Open Spray 376 kb
400-E-18 Storage Tank 414 kb
400-E-19 Particulate Matter Control Asbestos and/or Lead Removal Equipment 282 kb
400-E-21 Supplemental Permit Application for Dairy Farms 361 kb
400-E-22 Supplemental Permit Application for Laying Hen Ranches 354 kb
400-E-23 Supplemental Permit Application for Existing Agricultural Orchard Heaters 272 kb
Supplemental Package  Zip file of all forms listed above 12.3 Mb

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 320 kb
NOx/SOx-1 Monitoring, Reporting, and Recordkeeping (MRR) 417 kb
NOx/SOx–2 Recordkeeping Form for Major and Large Sources 202 kb
NOx/SOx–3 Recordkeeping Form for Process Units or Rule 219 Exempt Units with Fuel Meters 208 kb
NOx/SOx–4 Recordkeeping Form for Process Units or Rule 219 Exempt Units with Timers 219 kb
NOx/SOx–5 Recordkeeping Form for Non-Fuel Based Sources and Units 222 kb
QCE-1 Corrections to Monthly Reported Emissions (Major and Large Sources)
And Quarterly Reported Emissions (Process Units and Equipment Exempt Under Rule 219)
452 kb
QCER Quarterly Certification of Emissions Report 368 kb
Trading Forms
2007-1 Representative Registration and Certification 681 kb
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).
136 kb
2007-2 RECLAIM Trading Credits (RTCs) Transaction Registration
Instructions and Examples for Form 2007-2 (pdf 91kb)
268 kb
2007-3 RECLAIM Trading Credits (RTCs) Owner Identification 392 kb
2007-4A RECLAIM Trading Credits (RTCs) Report of Contingent Right to Purchase RTCs 194 kb
2007-4B RECLAIM Trading Credits (RTCs) Report of Forward Contract 189 kb
RECLAIM Package  Zip file of all forms listed above 4.1 Mb

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Title V Forms
To determine which forms are necessary, refer to the Title V Application Matrix (pdf 24.4kb).
Form Title Size
400-A Application Form for Permit or Plan Approval 324 kb
Form 400-A Instructions  
400-CEQA California Environmental Quality Act (CEQA) Applicability 326 kb
Form 400-CEQA Instructions 46 kb
CEQA Table 1-Q7 48 kb
CEQA Notice of Exemption Notice of Exemption [Letter to County] 245 kb
500-A1 Title V Permit Application Supplemental (NO LONGER USED)  
500-A2 Title V Application Certification 382 kb
500-ACC Report for Annual Compliance Certification 284 kb
500-B List of Exempt Equipment 308 kb
500-C1 Compliance Status Report  This form is now a fill-in form. 157 kb
500-C2 Non-Compliant Operations Report and Part 70 Compliance Schedule/Plan and Quality Improvement Plan - QIP 78 kb
500-D Permit Shield Request 266 kb
500-E Exclusion/Exemption Request 366 kb
500-F1 Title IV - Acid Rain Phase II Facility Information Summary 398 kb
500-F2 Title IV - Acid Rain Phase II Repowering Extension Plan 423 kb
500-F3 Title IV - Acid Rain Phase II New Unit Exemption Request 62 kb
500-F4 Title IV - Acid Rain Phase II Retired Unit Exemption Request 167 kb
500-G Hearing Request 268 kb
500-H Compliance Assurance Monitoring (CAM) Applicability Determination for Initial, Renewal & Significant Permit Revision 262 kb
500-MACT MACT Part 1 Application 264 kb
500-N Deviations, Emergencies & Breakdowns 333 kb
500-RO Delegation of Responsible Official 265.6 kb
500-SAM Semi-Annual Monitoring Report 388 kb
Title V Package   Zip file of all forms listed above 6.7 Mb

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br> This page updated: August 06, 2013
URL: http://www.aqmd.gov/permit/forms.html