Compliance Forms for Use in the Air Management Program

All facilites which have been issued an air operation permit are required to submit an annual or more frequent compliance certification, and compliance monitoring report to the DNR.   In addition to these submittals, facilites also need to submit other types of reports and notifications as required by their construction or operation permits and Wisconsin's air rules.   An example is the quarterly submittal of CEM excess emissions reports (EERs).

This web page contains DNR Forms that may be used by you to report data and information to the DNR.   The list below also indicates whether use of the form is required or optional.   As other DNR compliance forms are developed, they too will be placed on this web page.

DNR Compliance Forms

• Download the Compliance Certification form (OPTIONAL),
  Form 4530-170, revised 04/06 (51 KB Word)
  
• Download the Permit Summary Deviation form (OPTIONAL),
  Form 4530-171, revised 04/06 (40 KB Word)
• Download the instructions for filling out Forms 4530-170 & 4530-171 (80 KB Word)

• Download the Excess Emission Report for opacity (OPTIONAL),
  Form 4500-125, version 05/09, instructions on the back (71 KB Word)
• Download the Excess Emission Report for gases (OPTIONAL),
  Form 4500-126, version 05/09, instructions on the back (72 KB Word)
• Download the Fuel Sampling and Analysis Report (OPTIONAL),
  Form 4500-134, version 04/94, instructions on the back (64 KB Word)

• Download the Handling and Storage of Coal Certification Form, see s. NR 445.10, Wis. Adm. Code (OPTIONAL),
  Version 07/06 (37 KB Word)
• Download the Nonmetallic Mineral Processing Plant GOP Combined Annual Monitoring and Compliance Certification Report (OPTIONAL),
  Version 08/06 (42 KB Word)

If you have questions about any of the forms, please contact William.Baumann@wisconsin.gov, Section Chief, Compliance and Enforcement.