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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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Contact

  • Permit Services
    Ph: (909) 396-3385
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South Coast Air Quality Management District

21865 Copley Dr, Diamond Bar, CA 91765

909-396-2000

 

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