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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 air permit application materials to the department using either Option 1 or Option 2 below. To avoid processing delays, do not submit application materials to a regional office or to any specific permit writer or compliance engineer.

Option 1

Email an ELECTRONIC COPY* to DNRAMAirPermit@Wisconsin.gov

*Applications must be signed by the responsible official for the source. Upon receipt of an electronic application the department will send an email with instructions for e-Signing or submitting an ink signature. A photocopied or scanned signature does not meet the department’s signature requirements.


OR

Option 2

Mail the ORIGINAL  COPY of all materials with ink signature on form 4530-100 to the following address:

Wisconsin Department of Natural Resources
Air Management Program, AM/7
Attn: Permits
PO Box 7921
Madison WI 53707-7921

Application Fees

Some permit types require an application fee. Select the appropriate payment option and follow the instructions for submitting the fee on Form 4530-100.

Action on Applications

The department will not process air permit applications until the signature and required fees (if any) are submitted.

NEW REGULATED POLLUTANT: 1-Bromopropane (1-BP) was added to the hazardous air pollutants listed under section 112(b) of the Clean Air Act, effective February 4, 2022. In addition to the air contaminants listed in Table 3 of s. NR 407.05, Wis. Adm. Code, sources must also provide emission calculations for 1-BP in any air permit application. NOTE: A source’s major source status and applicable requirements may have changed as a result of the addition of 1-BP. For more information, see 1bp-q-and-a-document-final.pdf (epa.gov).

Forms and Application Checklists

Source Specific Forms/Checklists

Source Specific Permit And Exemption Application Checklists

These checklists contain all of the information that must be submitted when applying for an air pollution control permit or exemption, including links to application forms, helpful tips and submittal instructions. Use the download link to save a fillable PDF version to your computer.

Publication Number Description Download PDF Tutorials and Examples
AM-578 Operation Permit Renewal Application Checklist  Download
AM-597 Operation Permit Exemption Application Checklist  Download  
AM-598 Operation Permit Revision Application Checklist  Download  
AM-592 Construction Permit Revision Application Checklist  Download  
AM-593 Construction Permit Exemption Application Checklist  Download  
AM-594 PSD Major (NR 405) Construction Permit Application Checklist  Download  
AM-595 Minor Source (NR 406) Construction Permit Application Checklist  Download  

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.

Notice: To ensure proper functionality, always download Air Management Program PDF forms to the computer before opening and entering information. To download, click the link in the “Download PDF” column or right click on the document link, choose "Save link as", and save the file to a location on the computer. Open the downloaded file using Adobe Reader. For more information, visit the PDF help page.
 
Form Number Form Name Download Word Download PDF Tutorials and Examples
4530-100 Facility Details and Permit Actions  Download  Download  
4530-101 Facility Plot Plan    Download  
4530-102 Source and Site Descriptions    Download  
4530-102A Source Description - Supplemental    Download  
4530-102B Source Description - Supplemental    Download  
4530-103 Stack Identification  Download  Download  
4530-104 Boiler or Furnace Operation  Download  Download  
4530-104A Stationary Reciprocating Internal Combustion Engine (RICE)    Download  
4530-105 Storage Tanks  Download  Download  
4530-106 Incineration  Download  Download  
4530-107 Printing Operations  Download  Download  
4530-108 Painting and Coating  Download  Download  
4530-109 Miscellaneous Processes  Download  Download  
4530-110 Control Equipment Miscellaneous  Download  Download  
4530-111 Condensers  Download  Download  
4530-112 Adsorbers  Download  Download  
4530-113 Catalytic or Thermal Oxidation  Download  Download  
4530-114 Cyclone/Settling Chambers    Download  
4530-115 Electrostatic Precipitator  Download  Download  
4530-116 Wet Collection Systems  Download  Download  
4530-117 Baghouse/Fabric Filters  Download  Download  
4530-118 Compliance Certification - Monitoring and Reporting Methods  Download  Download  
4530-119 Continuous Emission Monitoring  Download    
4530-120 Period Emission Monitoring Using Portable Monitors  Download    
4530-121 Monitor Control System Parameters or Process Operating Parameters  Download    
4530-122 Monitoring Maintenance Procedures  Download    
4530-123 Stack Testing  Download    
4530-124 Fuel Sampling and Analysis  Download    
4530-125 Recordkeeping  Download    
AM-585 OP RENEWAL – Emission Summary Form Index (Forms 4530-126 through 4530-129)  Download  Download Tutorial [VIDEO]
4530-126 Emission Unit HAP Summary    Download  
4530-127 Facility HAP Summary    Download  
4530-128 Criteria Pollutant Emission Unit Summary    Download  
4530-129 Facility Criteria Pollutant Emissions Summary    Download
AM-586 OP RENEWAL – Applicable Requirements Form Index (Forms 4530-130 and 4530-132)  Download  Download Tutorial [VIDEO]
4530-130 Current Emission Requirements and Status of Unit    Download  
4530-132 Current Emissions Requirements and Status of Facility    Download  
AM-587 OP RENEWAL – Compliance Plan and Schedule Form Index (Forms 4530-131 and 4530-133)  Download  Download Tutorial [VIDEO]
4530-131 Emission Unit Compliance Plan and Schedule    Download  
4530-133 Facility Requirements Compliance Plan and Schedule    Download  
4530-135 Supplemental Information  Download    
4530-186 Generation and Banking of Emissions Reduction Credits (ERCs)  Download  Download  
4530-187 Transfer of Emissions Reduction Credits (ERCs)  Download  Download  
4530-188 Identification Of Emissions Offsets For A Nonattainment Area New Source Review (NNSR) Permit    Download  

General and Registration Permit Forms

General and Registration Permit Application Forms

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

Notice: To ensure proper functionality, always download Air Management Program PDF forms to the computer before opening and entering information. To download, click the link in the “Download PDF” column or right click on the document link, choose "Save link as", and save the file to a location on the computer. Open the downloaded file using Adobe Reader. For more information, visit the PDF help page.
 
Form Number Form Name Download PDF Download Word Resources
4530-141 to 144 Crushers General Operation Permits (GOP) A, B, C & Index    Download  
4530-156 Type A Registration Construction and Operation Permit Application  Download   Guide
4530-156A Type A Registration Construction and Operating Permit Modeling Assessment Attachment  Download    
4530-157 Permit & Order Revocation for Registration or General Permits  Download    
4530-163 Asphalt Plant General Construction Permit (GCP)/GOP (Draft)    Download  
4530-169 General and Registration Permit Petition  Download    
4530-172 Type C Registration Construction and Operation Permit for Printers Application  Document   Guide
4530-183 Type B Registration Construction and Operation Permit Application  Download  Download Guide
4530-185 Type G Registration Construction and Operation Permit Application  Download  Download Guide

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.

Notice: To ensure proper functionality, always download Air Management Program PDF forms to the computer before opening and entering information. To download, click the link in the “Download PDF” column or right click on the document link, choose "Save link as", and save the file to a location on the computer. Open the downloaded file using Adobe Reader. For more information, visit the PDF help page.
 
Form Number Form Name Download Document Instructions & Examples
4500-025 Portable Source Relocation Notification  Download Document  
4500-125 Excess Emission Report for opacity  Download Document  
4500-126 Excess Emission Report for gases  Download Document  
4500-134 Fuel Sampling and Analysis Report  Download Document  
4530-155 112(j) MACT Combined Parts 1 and 2  Download Document

PDF

Example [PDF]

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

 Download Document

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

Example 1 [PDF]

Example 2 [PDF]

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