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Air Quality Forms

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 Permit Application Forms

Form Title

State Form Number

Format
General Instructions for Completion of Permit Applications SFN-8514 SFN-8514 (pdf)
General Information Concerning Permitting Fee System   General Information Concerning Permitting Fee System

Hazardous Air Pollutant (HAP) Sources

SFN-8329

SFN-8329 (pdf)

Hazardous Air Pollutant (HAP) Sources (AP-117) (Word)

Air Contaminant Sources General

SFN-8516

SFN-8516 (pdf)

Air Contaminant Sources Instructions (AP-100)(Word)

Fuel Burning Equipment for Indirect Heating

SFN-8518

SFN-8518 (pdf)

Fuel Burning Equipment for Indirect Heating (AP-101) (Word)

Manufacturing or Processing Equipment

SFN-8520

SFN-8520 (pdf)

Manufacturing or Processing Equipment (AP 102) (Word)

Construct/Operate Incinerator

SFN-8522

SFN-8522 (pdf)

Construct/Operate Incinerator (AP-103) (Word)

Grain, Feed, Fertilizer Operations

SFN-8524

SFN-8524 (pdf)

Grain, Feed, Fertilizer Operations (AP-104) (Word)

Asphalt Concrete Plant

SFN-8526

SFN-8526 (pdf)
SFN-8526 (Word)

Rock, Sand and Gravel Plants

SFN-8530

SFN-8530 (pdf)

Rock, Sand and Gravel Plants (AP-108) (Word)

Gas Cleaning Equipment

SFN-8532

SFN-8532 (pdf)

Gas Cleaning Equipment (AP-109) (Word)

Volatile Organic Compounds Storage Tank

SFN-8535

SFN-8535 (pdf)

Volatile Organic Compounds Storage Tank (AP-112) (Word)

Internal Combustion Engine Sources

SFN-8891

SFN-8891 (pdf)

Internal Combustion Engine Sources (AP-113) (Word)

Flares

SFN-59652

SFN-8891 (pdf)

Internal Combustion Engine Sources (AP-113) (Word)

Natural Gas Processing Plant

SFN-11408

SFN-11408 (pdf)

Natural Gas Processing Plant (AP-107) (Word)

Oil/Gas Production Facility Registration

SFN-14334

SFN-14334 (pdf)

Oil/Gas Production Facility Registration (AP-114) (Word)

Glycol Dehydration Units

SFN-58923

SFN-14334 (pdf)

Oil/Gas Production Facility Registration (AP-114) (Word)

Minor/Synthetic Minor Permit Renewal Form

 

SFN-14334 (pdf)

Oil/Gas Production Facility Registration (AP-114) (Word)

 

   Annual Emission Inventory Report Forms

Form Title

State Form Number

Format

Fuel Burning Equipment Used for Indirect Heating
 (AP-301) 

SFN-8536

SFN-8536 (pdf)

Fuel Burning Equipment Used for Indirect Heating (Word)
Fuel Supplier Certification for Distillate Oil (40 CFR 60, Subpart Dc) (AP-119)

SFN-58172

 Fuel Supplier Certification for Distillate Oil (40 CFR 60, Subpart Dc) (AP-119) (pdf)
Fuel Supplier Certification for Distillate Oil (40 CFR 60, Subpart Dc) (AP-119) (Word)

Manufacturing or Processing Equipment (AP-302)

SFN-8537

SFN-8537 (pdf)

Manufacturing or Processing Equipment (AP-302) (Word)

Oil Seed Processing Equipment (AP-302S)

SFN-8539

SFN-8539 (pdf)

Oil Seed Processing Equipment (AP-302S) (Word)

Incinerators or Flares (AP-303)

SFN-11624

SFN-11624 (pdf)

Incinerators or Flares (AP-303) (Word)

Annual Production Report - Asphalt Plants (AP-305)

SFN-11828

SFN-11828 (pdf)

Annual Production Report - Asphalt Plants (AP-305) (Word)
Annual Production Report - Rock, Sand & Gravel Plant (AP-308)

SFN-51113

 Annual Production Report - Rock, Sand & Gravel Plant (AP-308) (pdf)
Annual Production Report - Rock, Sand & Gravel Plant (AP-308) (Word)

Compressor/Industrial Engines (AP-313)

SFN-11829

SFN-11829 (pdf)

Compressor/Industrial Engines (AP-313) (Word)

Volatile Organic Compounds Storage Tank (AP-312)

SFN-18682

SFN-18682 (pdf)

Volatile Organic Compounds Storage Tank (AP-312) (Word)

Hazardous Air Pollutant (AP-317)

SFN-19839

SFN-19839 (pdf)

Hazardous Air Pollutant (AP-317) (Word)

Incinerator and Flare Stack Sulfur Dioxide (AP-307)
Natural Gas Processing Plants

SFN-50596

SFN-50596 (pdf)

Incinerator and Flare Stack Sulfur Dioxide (AP-307) (Word)

Annual Production Report - Synthetic Minor (AP- 310)

SFN-51444

SFN-51444 (pdf)

Annual Production Report - Synthetic Minor (AP- 310) (Word)

 

     Title IV  Acid Rain

                                        Form Title                                      

   State Form Number   

     Format        

Retired Unit Exemption

SFN-53496

Department Memorandum, Title V Permit to Operate (pdf)

Title V Permit Renewal Application (Word)

Certificate of Representation

SFN-53497

SFN-53497 (pdf)

Title V Permit Renewal Application (Word)

New Unit Exemption

SFN-53498

SFN-53498 (pdf)

Title V Permit Renewal Application (Word)

Phase II NOx Averaging Plan

SFN-53499

SFN-53499 (pdf)

Title V Permit Renewal Application (Word)

Phase II NOx Compliance Plan

SFN-53500

SFN-53500 (pdf)

Title V Permit Renewal Application (Word)

Acid Rain Permit Application

SFN-53501

SFN-53501 (pdf)

Title V Permit Renewal Application (Word)

 

   Title V Application and Supporting Information

Form Title

State Form Number

Format

Department Memorandum, Title V Permit to Operate

 

Department Memorandum, Title V Permit to Operate (pdf)

Title V Permit Renewal Application

SFN-52824 

SFN-52824 (pdf)
Title V Permit Renewal Application (Word)

Title V Permit to Operate Application

 SFN-52858

SFN-52858 (pdf)

Title V Permit to Operate Application (Word)

Title V Permit to Operate Application Instructions

 

Title V Permit to Operate Instructions (pdf)

Title V Permit to Operate Instructions (Word)

Criteria Required for a Determination of a Complete
Title V Application

 

Criteria Required for a Determination of a Complete Title V Application (pdf)

Criteria Required for a Determination of a Complete Title V Application (Word Perfect)

Criteria Required for a Determination of a Complete Title V Application (Word)

List of Trivial Activities, Title V Permit Applications

 

List of Trivial Activities, Title V Permit Applications (pdf)

List of Trivial Activities, Title V Permit Applications (Word)

Compliance Assurance Monitoring (CAM) Guidance

 

Compliance Assurance Monitoring (CAM) Guidance (pdf)

Compliance Assurance Monitoring (CAM) Guidance (Word)

 

   Title V Reporting Forms

Form Title

State Form Number

Format

Title V Semi-annual Monitoring Report

 SFN-52737

SFN-52737 (pdf)

SFN-52737 (Word Perfect)

Title V Semi-annual Monitoring/Permit Deviation Report (Word)

Title V Annual Compliance Certification Report

 SFN-52738

SFN-52738 (pdf)
Title V Annual Compliance Certification Report (Word)

 

   Open Burning Forms     

Form Title

State Form Number

Format

Application for Approval to Burn Liquid Hydrocarbons

SFN-8506

SFN-8506 (pdf)

Application for Approval to Burn Liquid Hydrocarbons (Word)

Application for Open Burning Variance

SFN-8509

SFN-8509 (pdf)

SFN-8509 (Word)
Request for Prescribed Burn Approval   Request for Prescribed Burn Approval (pdf)
Request for Prescribed Burn Approval (Word)
Prescribed Burning Summary (residue loading factors)   Prescribed Burning Summary (residue loading factors) (pdf)
Prescribed Burning Summary (residue loading factors) (Word)

Notification of Demolition and Renovation

SFN-17987

SFN-17987 (pdf)

SFN-17987 (Word)

 

   Miscellaneous Forms

Form Title

 State Form Number

Format

Application for Aerial Application for Pesticide Over a City 

SFN-14493

SFN-14493 (pdf)
SFN-14493 (Word)

Asphalt Plant Change of Statues Notice (AP-205)

SFN-8455

 Asphalt Plant Change of Statues Notice (AP-205) (pdf)
Asphalt Plant Change of Statues Notice (AP-205) (Word)
Permit Application - Contaminated Soil Treatment Facility

SFN-52724

 Permit Application - Contaminated Soil Treatment Facility (pdf)
Permit Application - Contaminated Soil Treatment Facility (Word)

Visible Emission Observation Form

SFN-8441

Visible Emission Observation Form (pdf)

 

Copyright © 2005 North Dakota Department of Health
Email: health@nd.gov

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