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
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 | Tutorial [VIDEO] | ||
| 4530-100 | Facility Details and Permit Actions | |||
| 4530-101 | Facility Plot Plan | |||
| 4530-102 | Source and Site Descriptions | |||
| 4530-102A | Source Description - Supplemental | |||
| 4530-102B | Source Description - Supplemental | |||
| 4530-103 | Stack Identification | Word | ||
| 4530-104 | Boiler or Furnace Operation | Word | ||
| 4530-105 | Storage Tanks | Word | ||
| 4530-106 | Incineration | Word | ||
| 4530-107 | Printing Operations | Word | ||
| 4530-108 | Painting and Coating | Word | ||
| 4530-109 | Miscellaneous Processes | Word | ||
| 4530-110 | Control Equipment Miscellaneous | Word | ||
| 4530-111 | Condensers | Word | ||
| 4530-112 | Adsorbers | Word | ||
| 4530-113 | Catalytic or Thermal Oxidation | Word | ||
| 4530-114 | Cyclone/Settling Chambers | |||
| 4530-115 | Electrostatic Precipitator | Word | ||
| 4530-116 | Wet Collection Systems | Word | ||
| 4530-117 | Baghouse/Fabric Filters | Word | ||
| 4530-118 | Compliance Certification - Monitoring and Reporting Methods | Word | ||
| 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 | Tutorial [VIDEO] | |
| 4530-126 | Emission Unit HAP Summary | |||
| 4530-127 | Facility HAP Summary | |||
| 4530-128 | Criteria Pollutant Emission Unit Summary | |||
| 4530-129 | Facility Criteria Pollutant Emissions Summary | |||
| AM-586 | OP RENEWAL – Applicable Requirements Form Index (Forms 4530-130 and 4530-132) | Word | Tutorial [VIDEO] | |
| 4530-130 | Current Emission Requirements and Status of Unit | |||
| 4530-132 | Current Emissions Requirements and Status of Facility | |||
| AM-587 | OP RENEWAL – Compliance Plan and Schedule Form Index (Forms 4530-131 and 4530-133) | Word | Tutorial [VIDEO] | |
| 4530-131 | Emission Unit Compliance Plan and Schedule | |||
| 4530-133 | Facility Requirements Compliance Plan and Schedule | |||
| 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 | Alex Torres | |
| 4530-156A | Type A Registration Construction and Operating Permit Modeling Assessment Attachment | Alex Torres | |
| 4530-157 | Permit & Order Revocation for Registration or General Permits | Alex Torres | |
| 4530-163 | Asphalt Plant General Construction Permit (GCP)/GOP (Draft) | Word | Erin Hansel |
| 4530-169 | General and Registration Permit Petition | Kristin Hart | |
| 4530-172 | Type C Registration Construction and Operation Permit for Printers Application | Alex Torres | |
| 4530-173 | Printer General Construction/Operation Permit (GCP/GOP) Application (Draft) | Erin Hansel | |
| 4530-183 | Type B Registration Construction and Operation Permit Application | 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 | ||
| 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 | ||
| 4530-184 (replaces Forms 4530-170 and 4530-171) |
Air Operation Permit Compliance Certification & Deviation Summary Report | ||
| 4530-175 | Hot Mix Asphalt Plant GOP Combined Annual Monitoring Report and Certification of Compliance | ||
| 4530-177 | Nonmetallic Mineral Processing Plant GOP Combined Annual Monitoring Report and Certification of Compliance | ||
| 4530-178 | Air Pollution Registration Operation Permit (ROP)
|
||
| 4530-179 | Registration Operation Permit (ROP)
|
||
| 4530-182 | Air Permit Next Business Day Deviation | ||
| Handling and Storage of Coal Certification Form | Word | see s. NR 445.10, Wis. Adm. Code [exit DNR] |