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Air Permit and Compliance Forms

This page includes air permit application forms for source specific, general and registration permits, as well as forms for compliance activities for sources that have an air pollution control operation permit. 

Permit application submittal instructions

Submit all completed permit application materials to the department using either Option 1 or Option 2 below.

Option 1

Email ONE ELECTRONIC COPY* to DNRAMAirPermit@Wisconsin.gov

AND

Mail ONE HARD COPY to the following address:

Wisconsin Department of Natural Resources
Air Program, AM/7
Attn: Construction Permits (and/or Operation Permits, as appropriate)
PO Box 7921
Madison WI 53707-7921

Option 2

Mail TWO HARD COPIES to the following address:

Wisconsin Department of Natural Resources
Air Program, AM/7
Attn: Construction Permits (and/or Operation Permits, as appropriate)
PO Box 7921
Madison WI 53707-7921

*Note: The electronic copy counts as one of the two copies that are required by rule.

Forms

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Source Specific Permit Application Forms

Source Specific Permit Application Forms

Use these forms to apply for a source specific air pollution control permit. Each form includes instructions at the back. Wisconsin Air Pollution Control Permit Application - Form-by-Form Instructions (AM-565) includes expanded explanations and examples.

Form Number Form Name Word Document PDF Document Tutorials and Examples
AM-578 OP Renewal Application Checklist   PDF Tutorial [VIDEO]
4530-100 Facility Details and Permit Actions   PDF  
4530-101 Facility Plot Plan   PDF  
4530-102 Source and Site Descriptions   PDF  
4530-102A Source Description - Supplemental   PDF  
4530-102B Source Description - Supplemental   PDF  
4530-103 Stack Identification Word PDF  
4530-104 Boiler or Furnace Operation Word PDF  
4530-105 Storage Tanks Word PDF  
4530-106 Incineration Word PDF  
4530-107 Printing Operations Word PDF  
4530-108 Painting and Coating Word PDF  
4530-109 Miscellaneous Processes Word PDF  
4530-110 Control Equipment Miscellaneous Word PDF  
4530-111 Condensers Word PDF  
4530-112 Adsorbers Word PDF  
4530-113 Catalytic or Thermal Oxidation Word PDF  
4530-114 Cyclone/Settling Chambers   PDF  
4530-115 Electrostatic Precipitator Word PDF  
4530-116 Wet Collection Systems Word PDF  
4530-117 Baghouse/Fabric Filters Word PDF  
4530-118 Compliance Certification - Monitoring and Reporting Methods Word PDF  
4530-119 Continuous Emission Monitoring Word    
4530-120 Period Emission Monitoring Using Portable Monitors Word    
4530-121 Monitor Control System Parameters or Process Operating Parameters Word    
4530-122 Monitoring Maintenance Procedures Word    
4530-123 Stack Testing Word    
4530-124 Fuel Sampling and Analysis Word    
4530-125 Recordkeeping Word    
AM-585 OP RENEWAL – Emission Summary Form Index (Forms 4530-126 through 4530-129) Word PDF Tutorial [VIDEO]
4530-126 Emission Unit HAP Summary   PDF  
4530-127 Facility HAP Summary   PDF  
4530-128 Criteria Pollutant Emission Unit Summary   PDF  
4530-129 Facility Criteria Pollutant Emissions Summary   PDF  
AM-586 OP RENEWAL – Applicable Requirements Form Index (Forms 4530-130 and 4530-132) Word PDF Tutorial [VIDEO]
4530-130 Current Emission Requirements and Status of Unit   PDF  
4530-132 Current Emissions Requirements and Status of Facility   PDF  
AM-587 OP RENEWAL – Compliance Plan and Schedule Form Index (Forms 4530-131 and 4530-133) Word PDF Tutorial [VIDEO]
4530-131 Emission Unit Compliance Plan and Schedule   PDF  
4530-133 Facility Requirements Compliance Plan and Schedule   PDF  
4530-135 Supplemental Information Word    

General and Registration Permit Application Forms

General and Registration Permit Application Forms

These forms pertain to general and registration permits and permit exemptions.

Form Number Form Name Document Contact
4530-141 to 144 Crushers General Operation Permits (GOP) A, B, C & Index Word Erin Hansel
4530-156 Type A Registration Construction and Operation Permit Application PDF Alex Torres
4530-156A Type A Registration Construction and Operating Permit Modeling Assessment Attachment PDF Alex Torres
4530-157 Permit & Order Revocation for Registration or General Permits PDF Alex Torres
4530-163 Asphalt Plant General Construction Permit (GCP)/GOP (Draft) Word Erin Hansel
4530-169 General and Registration Permit Petition PDF Kristin Hart
4530-172 Type C Registration Construction and Operation Permit for Printers Application PDF Alex Torres
4530-173 Printer General Construction/Operation Permit (GCP/GOP) Application (Draft) PDF Erin Hansel
4530-183 Type B Registration Construction and Operation Permit Application PDF Alex Torres

Compliance Forms

Compliance Forms

These forms are related to compliance activities. All facilities which have been issued an air operation permit are required to submit an annual (or more frequent) compliance certification and compliance monitoring report to the DNR.

Note: The DNR has an online reporting system for facilities with these compliance requirements. Use this reporting system to submit these documents electronically to the DNR.

Form Number Form Name Documents Instructions & Examples
4500-025 Portable Source Relocation Notification PDF  
4500-125 Excess Emission Report for opacity Word  
4500-126 Excess Emission Report for gases Word  
4500-134 Fuel Sampling and Analysis Report Word  
4530-155 112(j) MACT Combined Parts 1 and 2 PDF

PDF

Example [PDF]

4530-184
(replaces Forms 4530-170 and 4530-171)
Air Operation Permit Compliance Certification & Deviation Summary Report PDF  
4530-175 Hot Mix Asphalt Plant GOP Combined Annual Monitoring Report and Certification of Compliance PDF  
4530-177 Nonmetallic Mineral Processing Plant GOP Combined Annual Monitoring Report and Certification of Compliance

Word

PDF

 
4530-178 Air Pollution Registration Operation Permit (ROP)
  • Section A - Annual Compliance Certification
  • Section B – Deviation Summary Report
PDF PDF
4530-179 Registration Operation Permit (ROP)
  • Section C - Monitoring Summary/Checklist
PDF
4530-182 Air Permit Next Business Day Deviation PDF

Example 1 [PDF]

Example 2 [PDF]

  Handling and Storage of Coal Certification Form Word see s. NR 445.10, Wis. Adm. Code [exit DNR]