Air Contaminant Discharge Permit (ACDPs) Forms

For questions or information requests regarding permitting forms contact LRAPA staff at permitting@lrapa.org or 541-736-1056.

Basic ACDP Forms

Initial Basic Air Contaminant Discharge Permit (ACDP) Application Forms
Forms Link (PDF)
Basic Air Contaminant Discharge Permit Application (Form Basic-100)
Form
Basic Boiler Permit Application (AQB-002)
Form
Basic Concrete Application (AQB-006)
Form
Basic Crematory Application (AQB-007)
Form
Basic Rock Crushing Application (AQB-015)
Form
Basic Surface Coating Application (AQB-018)
Form
Basic or General Coffee Roaster Application (AQB-116)
Form
Surface Coating (6H) Application for a General, Basic, or Registration (AQGP-127)
Form
Basic Wood Product Manufacturing (Sawmills & Millwork) Application
Form
Transfer Application for ACDP (Use for change in ownership) - AQ103 (Instructions and Application)
Form
Annual Reporting Forms for Basic Air Contaminant Discharge Permits (ACDPs)
Forms Link (PDF)
Surface Coating (6H) Annual Reporting Form for A11 Autobody Repair or Painting Shops (AQRB-001)
Form
Boilers Annual Reporting Form (AQRB-002)
Form
Concrete Manufacturing Annual Reporting Form (AQRB-006)
Form
Crematory Annual Reporting Form (AQRB-007)
Form
Wood Product Annual Reporting Form (AQRB-009)
Form
Rock, Concrete, and Asphalt Crushing Annual Reporting Form (AQRB-015)
Form
Surface Coating Annual Reporting Form for A7 and A8 (AQBP-R27)
Form

General ACDP Forms

Initial General Air Contaminant Discharge Permit (ACDP) Application Forms
Forms Link (PDF)
Administration Information for Assignment to General Permit (AQGP-100)
Form
Hard Chromium Electroplating General Application (AQGP-101)
Form
Decorative Chromium Electroplating General Application (AQGP-102)
Form
Dry Cleaner Application for General or Registration (AQGP-106)
Form
Asphalt Plant General Application (AQGP-107)
Form
Rock Crushers General Application (AQGP-108)
Form
Concrete Manufacturing General Application (AQGP-109)
Form
Wood Products Manufacturing (Sawmills & Millwork) Application (AQGP-110)
Form
Boilers General Application (AQGP-111) 
Form
Crematory Incinerators General Application (AQGP-112)
Form
Coffee Roaster General or Basic Application (AQGP-116)
Form
Electric Power Generators General Application (AQGP-118)
Form
Metal Fabrication and Finishing Operations General Application (AQGP-125)
Form
Plating and Polishing General Application (AQGP-126)
Form
Surface Coating (6H) Application for a General Permit, Basic, EcoBiz Certification or Registration (AQGP-127)
Form
Annual Reporting Forms for General Air Contaminant Discharge Permits (ACDPs)
Forms Link (PDF)
Dry Cleaners Annual Reporting Form (AQGP-R06)
Form
Asphaltic Concrete Plant Annual Reporting Form (AQGP-R07)
Form
Rock Crusher Annual Reporting Form (AQGP-R08)
Form
Concrete Production Annual Reporting Form (AQGP-R09)
Form
Wood Product Annual Reporting Form (AQGP-R10)
Form
Boiler Annual Reporting Form (AQGP-R11)
Form
Crematory Annual Reporting Form (AQGP-R12)
Form
Coffee Roaster Annual Reporting Form (AQGP-R16)
Form
Gasoline Dispensing Facility (GDF) Annual Reporting Form (AQGP-022)
Form
Metal Fabrication Operations (AQGP-R025)
Form
Plating and Polishing Operations (AQGP-R026) Form
Surface Coating (6H) Annual Reporting Form (AQGP-R027)
Form
Greenhouse Gas Reporting Form (R1001-G)
Form
Area Source National Emission Standards for Hazardous Air Pollutants (NESHAP) Forms and Information
Forms Link (PDF)
Initial Notification for Paint Stripping and Miscellaneous Surface Coating (6H) Form
Form
Petition for Exemption for Paint Stripping and Miscellaneous Surface Coating Operations (6H)
Form
Notification for Gasoline Dispensing Facilities (GDFs) - Form A
Form
Gasoline Dispensing Facility (GDF) Compliance Report
Form
Paint Stripping and Surface Coating Informational Pamphlet
Pamphlet
Gasoline Dispensing Facility (GDF) Stage I Pre-Test Vapor Recovery Notification Form
Form
Notification of Compliance Status Surface Coating (6H) Form
Form

ACDP Construction Forms

Air Contaminant Discharge Permit (ACDP) Construction Forms
Forms Link (PDF)
Notice of Intent to Construct Form (AQ104)
Form
Notice of Intent to Construct Instructions (AQ104 Instructions)
Instructions

Various Standard/Simple/General/Basic ACDP Forms

Various Air Contaminant Discharge Permit (ACDP) Forms
Forms Link (PDF)
Application Guidelines
Document
Administrative Information Form (AQ101)
Form
Administrative Information Form Instructions (AQ101 Instructions)
Instructions
Facility Description Instructions (AQ102)
Form
Transfer Application and Instructions - Use for Change in Ownership, etc. (AQ103)
Form
General and Basic ACDP Land Use Compatibility Statement (LUCS)
Form
Title V, Standard, Simple ACDP Land Use Compatibility Statement (LUCS)
Form
Local Government Contact Information for Land Use Compatibility Statement (LUCS)
Document
Non-Technical Modification Form for ACDPs (AQ105)
Form
Greenhouse Gas Reporting Form (R1001-G)
Form
Relocation Notification for Portable Plants
Form

ACDP Device and Equipment Forms (Series 200)

Series 200 Forms - (Instructions/Answer sheets/Device descriptions)
Forms Link (PDF)
Form Series 200 Guidelines
Document
Asphalt Plant (AQ202)
Form
Rock Crusher (AQ203)
Form
Ready-mix Concrete Plant (AQ204)
Form
VOC Containing Product Storage (AQ205)
Form
Material Dryers (non-wood products) (AQ206)
Form
Coffee Roasters (AQ207)
Form
Boilers (AQ208)
Form
Crematory Incinerator (AQ209)
Form
Internal Combustion Engines and Turbines (AQ210)
Form
Surface Coating Information  painting, coating, solvents (AQ211 I)
Document
Surface Coating Answer Sheet (AQ211 a)
Form
Power Supply Generators (AQ213)
Form
Solvent Usage - other than surface coating (AQ214)
Form
Commercial Bakeries (AQ216)
Form
Wood products facility data (AQ220)
Form
Veneer Dryer Process Device Description (AQ221)
Form
Wood Particle Dryer Process Device Description (AQ222)
Form
Wood Panel Press Process Device Description (AQ223)
Form
Hogged Fuel Boiler Process Device Description (AQ224)
Form
Wood Drying Kiln Process Device Description (AQ225)
Form
Wood Product Process Cyclone Process Device Description (AQ226)
Form
Miscellaneous Processes and Devices (AQ230)
Form
Operation and Maintenance (AQ231)
Form

ACDP Pollution Prevention and Control Forms (Series 300)

Series 300 Forms (Instruction/Answer sheets)
Forms Link (PDF)
Form Series 300 Guidelines
Document
Pollution Prevention (AQ301)
Form
Electrostatic Precipitators (ESP) Control Device (AQ302)
Form
Wet Scrubbers Control Devices (AQ303)
Form
Baghouse Control Devices (AQ304)
Form
Cyclone/Multiclone Control Devices (AQ305)
Form
Fume Incinerator Control Devices (AQ306)
Form
Miscellaneous Control Devices (AQ307)
Form

Emissions Forms (Series 400)

Series 400 Forms
Forms Link (PDF)
Form Series 400 Guidelines
Document
Plant Site Emissions Detail Baseline - Baseline Emissions Rate (AQ401)
Form
Plant Site Emissions Detail Sheet Current/Future Emissions (AQ402)
Form
Hazardous Air Pollutant (HAP) Emissions Detail Sheet (AQ403)
Form