Small Business Assistance - Permit Primer

Section 5 - Emissions Information Forms

Every construction or operation permit application must include these forms.

Pollutant Emission Rate Forms (Fill out forms -126 and -128 for each significant emissions unit and forms -127 and -129 for the whole facility)
4530-126 Emission Unit Hazardous Air Pollutant Summary
4530-127 Facility Hazardous Air Pollutant Summary
4530-128 Emission Unit Summary
4530-129 Facility Emissions Summary

4530-126

For each emission unit you must fill out a separate form. If many different materials are used for a particular emission unit, the applicant should review all materials and report the worst case emissions for each hazardous air pollutant (HAP). Do not fill out this form for insignificant emissions units. Attach a Material Safety Data Sheet (MSDS) for each material used or a representative MSDS for those materials that can be grouped as similar because the composition changes little beyond the pigment used for color.

4530-128

You must fill out one of these forms for each emissions unit at your facility. Do not fill out this form for insignificant emissions units. Be sure the unit identifications match up with forms 4530-102. Show and attach calculations on form 4530-135.

4530-127 & 4530-129

If you filled out form 4530-126 and/or 4530-128 in hard copy, you must also fill out these forms. Be sure the identifications match up with forms 4530-102. If you are using electronic forms, the emissions of each contaminant on 4530-126 and 4530-128 forms will automatically get added up and entered into form 4530-127 or 4530-129, respectively, so you can move on to the next form.

Alternative Operating Scenarios

While filling out your application, consider all the different operating scenarios you might want to operate under during the next five-year life of your permit. On some of the forms it is easy to address alternatives. For example, the printing form 4530-107 asks you to give information for all inks you currently use in your press and all inks you may want to use in the press for the next five years. Write "alternative" next to the inks that may be used in the future. Other forms don't lend themselves as easily to describing alternative operating scenarios. In this case, fill out a 4530-135 form for additional information to describe the alternative operating scenario (opens in new window)

Section 5 Forms (PDF, 43 KB)