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air permit options.
how to apply for permits.
an operation permit.
for a permit.
Contact information
Policy issues and permit applicability:
Kristin Hart
Dave Minkey
Mary Oleson
Permit application processes:
Megan Corrado
Air emissions inventory reporting:
Grant Hetherington
General permits:
Erin Hansel
Registration permits and performance based permits:
Alex Torres
For small businesses needing help with permits:
Small Business Environmental Assistance Program
For questions about compliance, contact:
Martha Makholm

Air permit and compliance forms

This page includes application forms for air permitting and some compliance/monitoring activities associated with air permitting. This form-by-form instruction document [PDF] offers expanded explanations of certain items as well as examples.

Submittal instructions

Submit all completed application materials to the department using either Option 1 or Option 2 below.

Option 1


Mail ONE HARD COPY to the following address:

Wisconsin Department of Natural Resources
Air Program, AM/7
Attn: Construction Permits (and/or Operation Permits, as appropriate)
PO Box 7921
Madison WI 53707-7921

Option 2
Mail TWO HARD COPIES to the following address:

Wisconsin Department of Natural Resources
Air Program, AM/7
Attn: Construction Permits (and/or Operation Permits, as appropriate)
PO Box 7921
Madison WI 53707-7921

*Note: The electronic copy counts as one of the two copies that are required by rule.


Notice: Some web browsers do not open PDF files on their own. If you experience trouble opening or filling out a PDF form, visit the DNR PDF help for instructions on how to successfully open PDF files.

Source specific

Source specific forms

These forms pertain to specific air pollution sources/emission units within a facility.

Form Number Form Name Word Document PDF Document
4530-100 Facility Details and Permit Actions
View instructions [PDF]
4530-101 Facility Plot Plan Word PDF
4530-102 Source and Site Descriptions Word PDF
4530-103 Stack Identification Word PDF
4530-104 Boiler or Furnace Operation Word PDF
4530-105 Storage Tanks Word PDF
4530-106 Incineration Word PDF
4530-107 Printing Operations Word PDF
4530-108 Painting and Coating Word PDF
4530-109 Miscellaneous Processes Word PDF
4530-110 Control Equipment Miscellaneous Word PDF
4530-111 Condensers Word PDF
4530-112 Adsorbers Word PDF
4530-113 Catalytic or Thermal Oxidation Word PDF
4530-114 Cyclone/Settling Chambers   PDF
4530-115 Electrostatic Precipitator Word PDF
4530-116 Wet Collection Systems Word PDF
4530-117 Baghouse/Fabric Filters Word PDF
4530-118 Compliance Certification - Monitoring and Reporting Methods Word PDF
4530-119 Continuous Emission Monitoring Word  
4530-120 Period Emission Monitoring Using Portable Monitors Word  
4530-121 Monitor Control System Parameters or Process Operating Parameters Word  
4530-122 Monitoring Maintenance Procedures Word  
4530-123 Stack Testing Word  
4530-124 Fuel Sampling and Analysis Word  
4530-125 Recordkeeping Word  
4530-126 Emission Unit HAP Summary Word  
4530-127 Facility HAP Summary Word  
4530-128 Emission Unit Summary Word  
4530-129 Facility Emissions Summary Word  
4530-130 Emission Requirements and Status of Unit Word  
4530-131 Emission Unit Compliance Plan Word  
4530-132 Emissions Requirements and Status of Facility Word  
4530-133 Facility Compliance Plan Word  
4530-135 Supplemental Information Word  

General and registration

General and registration forms

These forms pertain to general and registration permits and permit exemptions.

Form Number Form Name Document Contact
4530-141 to 144 Crushers General Operation Permits (GOP) A, B, C & Index Word Erin Hansel
4530-156 Type A Registration Construction and Operation Permit Application PDF Alex Torres
4530-156A Type A Registration Construction and Operating Permit Modeling Assessment Attachment PDF Alex Torres
4530-157 Permit & Order Revocation for Registration or General Permits PDF Alex Torres
4530-163 Asphalt Plant General Construction Permit (GCP)/GOP (Draft) Word Erin Hansel
4530-169 General and Registration Permit Petition PDF Kristin Hart
4530-172 Type C Registration Construction and Operation Permit for Printers Application PDF Alex Torres
4530-173 Printer General Construction/Operation Permit (GCP/GOP) Application (Draft) PDF Erin Hansel
4530-183 Type B Registration Construction and Operation Permit Application PDF Alex Torres


Compliance-related forms

These forms are related to compliance activities. 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.

Note: The DNR also has an online reporting system for facilities with these requirements. Facilities may use this reporting system to submit these documents electronically to the DNR.

Form Number Form Name Documents Instructions & Examples
4500-025 Portable Source Relocation Notification PDF  
4500-125 Excess Emission Report for opacity Word  
4500-126 Excess Emission Report for gases Word  
4500-134 Fuel Sampling and Analysis Report Word  
4530-155 112(j) MACT Combined Parts 1 and 2 PDF


Example [PDF]

(replaces Forms 4530-170 and 4530-171)
Air Operation Permit Compliance Certification & Deviation Summary Report PDF  
4530-175 Hot Mix Asphalt Plant GOP Combined Annual Monitoring Report and Certification of Compliance PDF  
4530-177 Nonmetallic Mineral Processing Plant GOP Combined Annual Monitoring Report and Certification of Compliance



4530-178 Air Pollution Registration Operation Permit (ROP)
  • Section A - Annual Compliance Certification
  • Section B – Deviation Summary Report
4530-179 Registration Operation Permit (ROP)
  • Section C - Monitoring Summary/Checklist
4530-182 Air Permit Next Business Day Deviation PDF

Example 1 [PDF]

Example 2 [PDF]

  Handling and Storage of Coal Certification Form Word see s. NR 445.10, Wis. Adm. Code [exit DNR]
Last revised: Friday May 03 2019