Forms


Permits (PTO/PTC)

For information on completing the forms and fees:

Form Name

SFN

Form Type

Air Contaminant Sources (Required for all minor/synthetic minor permit application packages.) 8516 Permit Application
Air Pollution Control Equipment 8532 Permit Application
Asphalt Concrete Plants 8526 Permit Application
Contaminated Soil Treatment Facilities 52724 Permit Application
Flares 59652 Permit Application
Fuel Burning Equipment for Indirect Heating 8518 Permit Application
Glycol Dehydration Units 58923 Permit Application
Grain, Feed, and Fertilizer Operations 8524 Permit Application
Hazardous Air Pollutant (HAP) Sources 8329 Permit Application
Incinerators/Crematories 8522 Permit Application
Internal Combustion Engines and Turbines 8891 Permit Application
Manufacturing or Processing Equipment 8520 Permit Application
Natural Gas Processing Plants 11408 Permit Application
Oil/Gas Production Facility Registration 14334 Permit Application
Permit Renewal/Registration Application (minor/synthetic minor) 60242 Permit Application
Rock, Sand and Gravel Plants 8530 Permit Application
Volatile Organic Compounds Storage Tank 8535 Permit Application
Permit Application for Perchloroethylene Dry Cleaning Facilities 60923 Permit Application
Title V Permit to Operate Application (Required for all Title V application packages.) 52858 Title V Program
Emission Unit for Title V Permit to Operate (One for each EU.) 61006 Title V Program
Flexible Permits Title V Permit to Operate 61007 Title V Program
Compliance Schedule & Plan for Title V Permit to Operate 61008 Title V Program
Title V Permit to Operate Application (.docx) (Required for all Title V application packages.) 52858 Title V Program
Emission Unit for Title V Permit to Operate (.docx)(One for each EU.) 61006 Title V Program
Flexible Permits Title V Permit to Operate (.docx) 61007 Title V Program
Compliance Schedule & Plan for Title V Permit to Operate (.docx) 61008 Title V Program
Title V Permit to Operate Renewal Application 52824 Title V Program
Title V Permit to Operate Renewal Application (.doc) 52824 Title V Program
Title V Permit to Operate Application (.doc) 52858 Permit Application

Annual Production

Form Name

SFN

Asphalt Plants 11828
Rock, Sand and Gravel Plants 51113
Synthetic Minor Source 51444

Annual Emissions Inventory Reports (AEIR)

Form Name

SFN

Compressor/Industrial Engines 11829
Fuel Supplier Certification for Distillate Oil
(40 CFR 60, Subpart Dc)
58172
Hazardous Air Pollutant 19839
Incinerators or Flares 11624
Incinerators & Flare Stack Sulfur Dioxide-
Natural Gas Processing Plants
50596
Manufacturing or Processing Equipment 8537
Oil Seed Processing Equipment 8539
Volatile Organic Compounds Storage Tank 18682
Fuel Burning Equipment Used for Indirect Heating 8536

Acid Rain Program

Form Name

SFN

Retired Unit Exemption 53496 Acid Rain Program
Certificate of Representation 53497 Acid Rain Program
New Unit Exemption 53498 Acid Rain Program
Phase II NOx Averaging Plan 53499 Acid Rain Program
Phase II NOx Compliance Plan 53500 Acid Rain Program
Acid Rain Permit Application 53501 Acid Rain Program

Miscellaneous

Form Name

SFN

Application for Approval to Burn Liquid Hydrocarbons 8506 Open Burning Program
Application for Open Burn Variance 8509 Open Burning Program
Request for Approval to Open Burn (Rx Burns) 60925 Open Burning Program
Prescribed Burn Summary 60924 Open Burning Program
Application for Aerial Application for Pesticide Over A City 14493 Aerial Spraying Program
Hot Mix Asphalt Plant Change of Status Notice 8455 Miscellaneous Forms
Visible Emission Observation Form 8441 Miscellaneous Forms
Title V Annual Compliance Certification Report (.doc) 52738 Reporting
Certificate of Representation 61205 Miscellaneous Forms

All Forms

Form Name

SFN

Air Contaminant Sources (Required for all permit application packages.) 8516 Permit Application
Air Pollution Control Equipment 8532 Permit Application
Asphalt Concrete Plants 8526 Permit Application
Contaminated Soil Treatment Facilities 52724 Permit Application
Flares 59652 Permit Application
Fuel Burning Equipment for Indirect Heating 8518 Permit Application
Glycol Dehydration Units 58923 Permit Application
Grain, Feed, and Fertilizer Operations 8524 Permit Application
Hazardous Air Pollutant (HAP) Sources 8329 Permit Application
Incinerators/Crematories 8522 Permit Application
Internal Combustion Engines and Turbines 8891 Permit Application
Manufacturing or Processing Equipment 8520 Permit Application
Natural Gas Processing Plants 11408 Permit Application
Oil/Gas Production Facility Registration 14334 Permit Application
Permit Renewal/Registration Application 60242 Permit Application
Rock, Sand and Gravel Plants 8530 Permit Application
Volatile Organic Compounds Storage Tank 8535 Permit Application
Asphalt Plants 11828 Annual Production Report
Rock, Sand and Gravel Plants 51113 Annual Production Report
Synthetic Minor Source 51444 Annual Production Report
Compressor/Industrial Engines 11829 Annual Emissions Inventory Report
Fuel Supplier Certification for Distillate Oil
(40 CFR 60, Subpart Dc)
58172 Annual Emissions Inventory Report
Hazardous Air Pollutant 19839 Annual Emissions Inventory Report
Incinerators or Flares 11624 Annual Emissions Inventory Report
Incinerators & Flare Stack Sulfur Dioxide-
Natural Gas Processing Plants
50596 Annual Emissions Inventory Report
Manufacturing or Processing Equipment 8537 Annual Emissions Inventory Report
Oil Seed Processing Equipment 8539 Annual Emissions Inventory Report
Volatile Organic Compounds Storage Tank 18682 Annual Emissions Inventory Report
Retired Unit Exemption 53496 Acid Rain Program
Certificate of Representation 53497 Acid Rain Program
New Unit Exemption 53498 Acid Rain Program
Phase II NOx Averaging Plan 53499 Acid Rain Program
Phase II NOx Compliance Plan 53500 Acid Rain Program
Acid Rain Permit Application 53501 Acid Rain Program
Title V Permit to Operate Renewal Application 52824 Title V Program
Title V Semi-Annual Monitoring Report 52737 Title V Program
Title V Annual Compliance Certification Report 52738 Title V Program
Application for Approval to Burn Liquid Hydrocarbons 8506 Open Burning Program
Application for Open Burn Variance 8509 Open Burning Program
Request for Approval to Open Burn (Rx Burns) 60925 Open Burning Program
Prescribed Burn Summary 60924 Open Burning Program
Asbestos Notification of Demolition & Renovation 17987 Asbestos Program
Application for Aerial Application for Pesticide Over A City 14493 Aerial Spraying Program
Hot Mix Asphalt Plant Change of Status Notice 8455 Miscellaneous Forms
Visible Emission Observation Form 8441 Miscellaneous Forms
Permit Application for Perchloroethylene Dry Cleaning Facilities 60923 Permit Application
Title V Annual Compliance Certification Report (.doc) 52738 Reporting
Title V Permit to Operate Renewal Application (.doc) 52824 Title V Program
Fuel Burning Equipment Used for Indirect Heating 8536
Title V Permit to Operate Application (Required for all Title V application packages.) 52858 Title V Program
Emission Unit for Title V Permit to Operate (One for each EU.) 61006 Title V Program
Flexible Permits Title V Permit to Operate 61007 Title V Program
Compliance Schedule & Plan for Title V Permit to Operate 61008 Title V Program
Title V Permit to Operate Application (.docx) (Required for all Title V application packages.) 52858 Title V Program
Emission Unit for Title V Permit to Operate (.docx)(One for each EU.) 61006 Title V Program
Flexible Permits Title V Permit to Operate (.docx) 61007 Title V Program
Compliance Schedule & Plan for Title V Permit to Operate (.docx) 61008 Title V Program
Certificate of Representation 61205 Miscellaneous Forms

Radiation Control

Form Name

SFN

Notice to Employees-Standards for Radiation Protection (RCP-1) 8414
Current Occupational Radiation Exposure (RCP-2) 8416
Occupational Radiation Exposure History (RCP-3) 19443
Radiation Machine Registration (RCP-4) 8428
Radiation Machine Registration-[Out-of-State Reciprocity] (RCP-5) 7590
Radiation Machine Registration-Change of Status Notification (RCP-6) N/A
Health Physics Registration (RCP-7) N/A
Assembler Registration (RCP-8) N/A
Radiation Safety Documents for Radiation Machine Registrants (RCP-9) N/A
Application for Radioactive Material License (RCP-10) 8418
Application for TENORM Transporter Radioactive Material License (RCP-11) 60265
Radioactive Material Reciprocity Request (RCP-12) 58230
Certificate: Disposition of Radioactive Material (RCP-13) 18941
DOT Exemption Requests for Low Levels of External Radiation (RCP-14): DOT-SP 10656-Shippers & Carriers of Scrap Metal-Special Permit N/A
DOT Exemption Requests for Low Levels of External Radiation (RCP-14): DOT-SP 10656-Shippers & Carriers of Scrap Metal Shipment-Approval Form N/A
DOT Exemption Requests for Low Levels of External Radiation (RCP-14): DOT-SP 11406-Shippers & Carriers of Liquid & Solid Waste-Special Permit N/A
DOT Exemption Requests for Low Levels of External Radiation (RCP-14): DOT-SP 11406-Shippers & Carriers of Liquid & Solid Waste-Shipment Approval Form N/A
Radiation Safety Documents for Radioactive Materials (RCP-15) N/A
Radiological Emergency Assistance (RCP-16) N/A
Facility Close-Out Form/Property Release and/or License Termination Checklist (RCP-17) 58229
Certificate: In-Vitro Testing with Radioactive Material Under General License (RCP-18) 8423
Registration Certificate: Use of Depleted Uranium Under General License (RCP-19) 16092
Radiological Emergency Response Volunteer (RCP-20) 58237
Guidance for the NRC 313A Forms N/A
Radiation Safety Officer (NRC 313A RSO) N/A
Authorized Medical Physicist (NRC 313A AMP) N/A
Authorized Nuclear Pharmacist (NRC 313A ANP) N/A
Authorized User Training & Experience & Preceptor Attestation - [Imaging and localization studies, Uptake dilution, and excretion studies, and Sealed sources of diagnosis uses.] (NRC 313A AUD) N/A
Authorized User Training & Experience & Preceptor Attestation - [Use of unsealed byproduct material for which a directive is required. Oral administration of sodium iodide I-131 requiring a written directive in quantities less than or equal to 1.22 gigabecquerels (33 millicuries). Oral administration of sodium iodide I-131 requiring a written directive in quantities greater than 1.22 gigabecquerels (33 millicuries). Parenteral administration of any beta-emitter, or photon-emitting radionuclide with a photon energy less than 150 keV for which a written directive is required. Parenteral administration of any other radionuclide for which a written directive is required uses.] (NRC 313A AUT) N/A
Authorized User Training & Experience & Preceptor Attestation - [Manual brachytherapy sources, Ophthalmic use of strontium-90, Remote afterloader unit(s), Teletherapy unit(s), and Gamma stereotactic radiosurgery unit(s) uses.] (NRC 313A AUS) N/A


Asbestos

Form Name

SFN

Form Type

Asbestos Waste Manifest Form 58174 Asbestos
Asbestos Notification of Demolition and Renovation 17987 Asbestos
Asbestos Certification Application 16610 Asbestos
Asbestos Contractor License Application 16611 Asbestos

Lead-Based Paint

Form Name

SFN

Form Type

Asbestos Waste Manifest Form 58174 Asbestos
Asbestos Notification of Demolition and Renovation 17987 Asbestos
Asbestos Certification Application 16610 Asbestos
Asbestos Contractor License Application 16611 Asbestos

Last Updated: 01/05/2018