This form should be used for all air permitting actions, including both construction and operation. This form has the sections of the application as separate Word or Excel documents. All applicable and/or required sections should be completed and submitted with each air permitting action. If you have questions, comments, or suggestions regarding the form, please contact Iva Pilgrim.
February 22, 2022 (effective immediately): Added new HAP, 1-Bromopropane, to HAP dropdown list in Section B.3. Refer to EPA’s website for more information on the new HAP, including a Q&A Document.
Air Application Form
Revisions: August 23, 2021 (effective immediately)
• Section A (Facility Information) – Removed last page, which required the number of Sections completed. The minimum requirements are already outlined in the Instructions.
• Section B (Emissions Inventory)
-Added worksheet B.0 (Emission Point Description and Status), which must be completed providing a brief description of each Emission Point, its operating status, and any control devices.
-Revised worksheet B.3 (Hazardous Air Pollutants) to only require individual HAPs be reported for an emission point if the potential emissions exceed 0.01 tons per year (tpy).
-Revised worksheet B.4 (Greenhouse Gases), to require this worksheet for sources that have or will require a Title V Operating Permit and for sources in the energy and oil and gas sectors (i.e., SIC codes beginning with 13, 29, 46, and 49) regardless of Title V applicability.
• Section D (Internal Combustion Sources)
-Renamed Section to indicate it covers both engines and turbines.
-Grouped information required for an Engine together, followed by information for a Turbine.
-Inserted a Question “O” to indicate if the engine is certified by EPA to meet the applicable emissions standards.
• Section N (Applicable Requirements) – Revised instructions to request greater specificity and updated regulatory citations in the footnotes.
• Air Application Form 5 Instructions – Revised to reflect the updates above, update information such as websites, and provide for submittal of only one hard copy and one electronic copy of the application form.
May 5, 2020 (effective immediately)
Form 5, Appendix C – Air Quality Analysis Checklist
- Revised the checklist to reflect updates to Appendix W and related guidance, including alternative models and meteorological data.
July 6, 2018 (effective immediately)
Form 5, Instructions
- Clarified Item 2.A.4 to indicate that the option to designate a Duly Authorized Representative to sign an application is limited to Corporations, consistent with 11 Miss. Admin. Code Pt. 2, R. 6.1.A(26).
Form 5, Section A – Facility Information
- Added a fillable blank to Item 1.G.2 to specify coordinate system.
- Added Item 12 to require applications to include proof of registration with the Mississippi Secretary of State and/or a Certificate of Good Standing.
12. MS Secretary of State Registration/Certificate of Good Standing
No permit will be issued to a company that is not authorized to conduct business in Mississippi. If the company applying for the permit is a corporation, limited liability company, a partnership or a business trust, the application package should include proof of registration with the Mississippi Secretary of State and/or a copy of the company’s Certificate of Good Standing. The name listed on the permit will include the company name as it is registered with the Mississippi Secretary of State.
It should be noted that for an application submitted in accordance with 11 Miss. Admin. Code Pt. 2, R. 2.8.B. to renew a State Permit to Operate or in accordance with 11 Miss. Admin. Code Pt. 2, R. 6.2.A(1)(c). to renew a Title V Permit to be considered timely and complete, the applicant shall be registered and in good standing with the Mississippi Secretary of State to conduct business in Mississippi.
Form 5, Section N – Applicable Requirements and Status (Future Requirements)
- Remove last sentence in Future Requirements instructions requesting indication of compliance status.
- Revise footnote to state applicant is certifying to comply with Future Requirements in a timely manner.
