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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:
- Check AQMD
Rule 219 to determine if
the equipment is exempt from
requiring a permit.
- If the equipment is
exempt as per Rule 219,
check
Rule 222 to determine if
the equipment is subject to
filing requirements.
- If your equipment is
subject to filing
requirements, see
Rule 222 Filing Program
for more information on
filing.
To apply for a permit:
- 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
|
| 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. |
246 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 |
|
Change of Operator Guidelines |
47 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. |
3.0
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. |
320 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. |
83 kb |
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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 |
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 |
263
kb |
|
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
UPDATED FORM! 2/7/2011
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 |
64 kb |
|
500-SAM |
Semi-Annual Monitoring
Report |
388
kb |
|
Title V Package Zip file of all forms listed above |
5.7
Mb |
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