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OAQ Permit Renewal Application Air Permit Renewal Checklist Form. This is a Indiana form and can be use in Department Of Enviromental Management Statewide.
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OAQ PERMIT RENEWAL APPLICATION
Air Permit Renewal Checklist
State Form 51755 (R / 12-08)
INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT
IDEM - Office of Air Quality - Permits Branch
100 N. Senate Avenue, MC 61-53, IGCN Room 1003
Indianapolis, IN 46204-2251
Telephone: (317) 233-0178 or
Toll Free: 1-800-451-6027 x30178 (within Indiana)
Facsimile Number: (317) 232-6749
www.in.gov/idem/permits/air/index.html
•
The purpose of the Air Permit Application Renewal Checklist is to provide a worksheet for quickly assessing whether the air permit
renewal application includes all necessary information.
•
NOTES:
Detailed instructions for this checklist are available online at
www.in.gov/idem/permits/air/apps/instructions/renewalinstructions.html.
•
All information submitted to IDEM will be made available to the public unless it is submitted under a claim of confidentiality. Claims of
confidentiality must be made at the time the information is submitted to IDEM, and must follow the requirements set out in
326 IAC 17.1-4-1. Failure to follow these requirements exactly will result in your information becoming a public record, available for
public inspection.
Air Permit Renewal Checklist
Complete the checklist, placing a check in the box corresponding to the completion
status of each item listed.
1.
2.
3.
INFORMATION
PROVIDED
NOT
APPLICABLE
Original Air Operating Permit Number:
Air Permit Application Cover Sheet
– includes application tracking information and the signed certification for the
renewal application
General Source Data (GSD-01) Form
– includes basic source information, contact information, process/emissions
unit update information, and local library information
4.
Compliance Schedule and Certification (CD-04) Form (Title V Sources Only).
5.
Compliance Assurance Monitoring (CAM) Form - FED-03 (Title V Sources
Only).
List of exempt, trivial and/or insignificant activities added since issuance of the
original permit (if applicable)
List of emission units removed since issuance of the original permit (if
applicable)
List of all Notice Only Changes, Administrative Amendments, Revisions,
and/or Modifications to the original Air Operating Permit.
6.
7.
8.
⇒
List Permit Numbers Below:
Documentation illustrating any changes to the original operating permit
needed/requested beyond what has already been approved through a permit
action.
The responsible official (or authorized individual) has certified the air permit
10.
application by signing the application cover sheet.
Notes: This space is being provided for inclusion of any additional notes that may assist IDEM, OAQ in preparing the
11.
renewal permit. You may also attach a letter to the air permit renewal application if additional clarification is needed.
9.
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