The following forms are in PDF format and are fillable with current or earlier versions of Adobe Acrobat Reader. However, to save a copy of the completed forms, you will need a full version of Adobe Acrobat 7.0 or later.
Many of the forms are continually updated.
Please use the current forms below for your submittals.
To determine if your equipment needs a permit or is subject to a filing requirement:
- Check SCAQMD Rule 219 to determine if the equipment is exempt from requiring a permit.
- If the equipment is exempt as per Rule 219, check Rule 222 to determine if the equipment is subject to filing requirements.
- If your equipment is subject to filing requirements, see Rule 222 Filing Program for more information on filing.
To apply for a permit:
- Submit Form 400A, Form 400-CEQA, Form 400-PS and a supplemental Form 400-E-xx (for certain equipment type) for each equipment along with applicable fees (Fee Calculator). See Common Operations and Equipment for a list of equipment with respective forms and contact information.
If you need assistance with filing an application, see the Permitting Staff Locator for a directory of contacts for your particular equipment or business type or call Permit Services at 909-396-3385.
Administrative Forms
- Name Change
- Mailing Address Change
- Inactivate Permit
- Reinstate Permit
- Change of Operator
- Additional Operator
| ERC Form
Emission Reduction Credit - Certificate of Title
|
Other Forms
Other forms not directly used for permitting
|
Basic Forms for Permits and Plans
To be submitted with all applications for permits and plans (except registered equipment). IncludeSupplemental Application Forms (Forms 400-E-xx)with the appropriate fees when applying for a Permit to Operate.
| Supplemental Application Forms (400-E-XX)
Equipment specific forms to be included with Basic Forms when applying for a Permit to Operate.
|
RECLAIM Forms
For RECLAIM and RECLAIM/Title V facilities.
| Title V Forms
Title V application and reporting forms.
|
ADMINISTRATIVE FORMS | Form | Title | Size |
| 200-A | Business Name Change Notification
Name change only. Not for Change of Operator/Owner. | 245kb |
| 200-B | Mailing Address Update/Correction
Mailing address change only. Not for change of equipment location. | 939kb |
| 200-C | Request to Inactivate a Permit to Operate
For equipment that has been removed or shut down. | 277kb |
| 200-D | Request to Reinstate Expired Application or Permit to Operate
For reactivating expired applications and permits. Back fees and reinstatement fees may apply. | 1.15MB
|
| 400-AO | Application for Additional Operator
For a permit to be issued to an additional operator. | 326kb |
| 400-CO | Application for Change of Operator
For sale of a business, change of ownership, or change in the equipment operator. Fees required. | 909kb |
| Administrative Package Zip file of all forms listed above and SCAQMD Form 401. | 4.3MB
|
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ERC FORM | Form | Title | Size |
| 401 | Application for Emission Reduction Credit (ERC) Certificate of Title
For new ERC and change or modifications to ERC. (2013.07) | 944kb |
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OTHER FORMS | Form | Title | Size |
| AB3205 | AB3205 School Site Grid Search Request form.
Pursuant to California education code 17213, this request is for the identification of all SCAQMD permitted facilities with the potential to emit hazardous air pollutants located within 1/4 mile of a school site. | 173kb |
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BASIC FORMS FOR PERMITS AND PLANS [Return to Top]
SUPPLEMENTAL APPLICATION FORMS (400-E-XX)
These forms are to be submitted with the Basic Forms when applying for a permit. Choose a form below according to the type of equipment. If a specific equipment type form is not listed below, use 400-E-GI.
| Form | Title | Size |
| 400-E-GI | General Information Summary
Use this form if a specific equipment form is not available below. | 73kb |
| 400-E-1a | Particulate Matter Control Fabric Filter (Baghouse)/Cartridge Collector | 653kb |
| 400-E-1b | Particulate Matter Control Cyclone Separator | 426kb |
| 400-E-1c | Particulate Matter ControlElectrostatic Precipitator (ESP) | 419kb |
| 400-E-2a | Gaseous Emission Control Form Afterburner/Oxidizer | 438kb |
| 400-E-2b | Gaseous Emission Control Form Adsorber (Carbon, Others) | 310kb |
| 400-E-2c | Gaseous Emission Control Form Flare | 233kb |
| 400-E-3 | Scrubber | 269kb |
| 400-E-4a* | Portable/Open Abrasive Blasting Equipment | 354kb |
| 400-E-4b* | Abrasive Blasting Equipment (Other Than Portable/Open) | 420kb |
| 400-E-5 | Selective Catalytic Reduction (SCR) System, Oxidation Catalyst and Ammonia Catalyst | 379kb |
| 400-E-7 | Dry-Cleaning Equipment | 313kb |
| 400-E-8 | Ethylene Oxide Sterilizer | 310kb |
| 400-E-9a* | External Combustion Boiler/Heater | 327kb |
| 400-E-9b | External Combustion Oven | 318kb |
| 400-E-9c | External Combustion Solder Reflow/Wave/Hot Air Leveling Machine | 316kb |
| 400-E-9d | External Combustion Burn Off Furnaces/Brake Debonders/Wax Burnoff Furnaces | 326kb |
| 400-E-9e | External Combustion Food Broiler/Fryer | 316kb |
| 400-E-9f | External Combustion Metal Melting & Heat Treating Furnaces | 344kb |
| 400-E-10 | Degreaser | 310kb |
| 400-E-11* | Fuel Dispensing and Storage Equipment | 488kb |
| 400-E-12 | Gas Turbine | 360kb |
| 400-E-13a* | Emergency Internal Combustion Engine | 198kb |
| 400-E-13b | Non-Emergency Internal Combustion Engine | 355kb |
| 400-E-14 | Open Process Tank | 354kb |
| 400-E-15 | Printing Equipment | 328kb |
| 400-E-16 | Storage Tank Solid Material | 295kb |
| 400-E-17a* | Powder Coating Operation | 360kb |
| 400-E-17b | Spray Booth/Open Spray | 376kb |
| 400-E-18 | Storage Tank | 414kb |
| 400-E-19 | Particulate Matter Control Asbestos and/or Lead Removal Equipment | 282kb |
| 400-E-20-Form | Plasma Arc/Laser Cutter | 534kb |
| 400-E-21 | Supplemental Permit Application for Dairy Farms | 361kb |
| 400-E-22 | Supplemental Permit Application for Laying Hen Ranches | 354kb |
| 400-E-23 | Supplemental Permit Application for Existing Agricultural Orchard Heaters | 272kb |
| Supplemental Package Zip file of all forms listed above | 12.3MB
|
* These forms are 'intelligent' forms which perform basic emissions calculations as you enter data. The forms also show standard permit conditions for the equipment. NOTE: The actual permit conditions may differ upon thorough review of your application.
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RECLAIM FORMS | Monitoring, Recordkeeping & Reporting Forms |
| Form | Title | Size |
| CERE | Corrections to Electronically Reported Emissions | 320kb |
| NOx/SOx-1 | Monitoring, Reporting, and Recordkeeping (MRR) | 417kb |
| NOx/SOx–2 | Recordkeeping Form for Major and Large Sources | 202kb |
| NOx/SOx–3 | Recordkeeping Form for Process Units or Rule 219 Exempt Units with Fuel Meters | 208kb |
| NOx/SOx–4 | Recordkeeping Form for Process Units or Rule 219 Exempt Units with Timers | 219kb |
| NOx/SOx–5 | Recordkeeping Form for Non-Fuel Based Sources and Units | 222kb |
| QCE-1 | Corrections to Monthly Reported Emissions (Major and Large Sources)
And Quarterly Reported Emissions (Process Units and Equipment Exempt Under Rule 219) | 452kb |
| QCER | Quarterly Certification of Emissions Report | 368kb |
| Trading Forms |
| 2007-1 | Representative Registration and Certification | 752kb |
| Attachment A | Designation of Agent for Service of Process and Consent to California Jurisdiction
To be used in conjunction with Form 2007-1 for entities not domiciled with the State of California and who are not RECLAIM Facility Permit holders.
Note: Attachment A includes requirement for a certification, contract or other documentation provided bythe designated Agent for Service of Process. Such documentation shall include:
A. The agent is a licensed Agent for Service of Process in the State of California,
B. The appointing entity (i.e. RTC trader), the start and end date of the appointment,
If the appointment is LESS THAN 4 years from the date of receipt, then:
C. Statement that the appointing entity has requested appointment of 4 or more years, and
D. Maximum term of appointment/contract that the Agent for Service of Process would accept (e.g. annual, bi-annual). | 136kb |
| 2007-2 | RECLAIM Trading Credits (RTCs) Transaction Registration
Instructions and Examples for Form 2007-2(pdf 91kb) | 268kb |
| 2007-3 | RECLAIM Trading Credits (RTCs) Owner Identification | 392kb |
| 2007-4A | RECLAIM Trading Credits (RTCs) Report of Contingent Right to Purchase RTCs | 194kb |
| 2007-4B | RECLAIM Trading Credits (RTCs) Report of Forward Contract | 189kb |
| RECLAIM Package Zip file of all forms listed above | 4.1MB |
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Title V Forms
To determine which forms are necessary, refer to the TV-Application-Matrix (pdf 24.4kb).
| Form | Title | Size |
| 400-A | Application Form for Permit or Plan Approval | 363kb |
| Form 400-A Instructions | 91kb |
| 400-CEQA | California Environmental Quality Act (CEQA) Applicability | 367kb |
| Form 400-CEQA Instructions | 67kb |
| CEQA Table 1-Q7 | 78kb |
| CEQA Notice of Exemption | Notice of Exemption [Letter to County] | 245kb |
| 500-A1 | Title V Permit Application Supplemental (NO LONGER USED) | |
| 500-A2 | Title V Application Certification | 382kb |
| 500-ACC | Report for Annual Compliance Certification | 284kb |
| 500-B | List of Exempt Equipment | 308kb |
| 500-C1 | Compliance Status Report This form is now a fill-in form. | 157kb |
| 500-C2 | Non-Compliant Operations Report and Part 70 Compliance Schedule/Plan and Quality Improvement Plan - QIP | 78kb |
| 500-D | Permit Shield Request | 266kb |
| 500-E | Exclusion/Exemption Request | 366kb |
| 500-F1 | Title IV - Acid Rain Phase II Facility Information Summary | 398kb |
| 500-F2 | Title IV - Acid Rain Phase II Repowering Extension Plan | 423kb |
| 500-F3 | Title IV - Acid Rain Phase II New Unit Exemption Request | 62kb |
| 500-F4 | Title IV - Acid Rain Phase II Retired Unit Exemption Request | 167kb |
| 500-G | Hearing Request | 268kb |
| 500-H | Compliance Assurance Monitoring (CAM) Applicability Determination for Initial, Renewal & Significant Permit Revision | 262kb |
| 500-MACT | MACT Part 1 Application | 264kb |
| 500-N | Deviations, Emergencies & Breakdowns | 333kb |
| 500-RO | Delegation of Responsible Official | 265.6kb |
| 500-SAM | Semi-Annual Monitoring Report | 388kb |
| Title V Package Zip file of all forms listed above | 6.7MB |
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