DEQ Form 100-883 "Request for Transfer and Administrative Amendment of Permit" - Oklahoma

What Is DEQ Form 100-883?

This is a legal form that was released by the Oklahoma Department of Environmental Quality - a government authority operating within Oklahoma. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 10, 2007;
  • The latest edition provided by the Oklahoma Department of Environmental Quality;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of DEQ Form 100-883 by clicking the link below or browse more documents and templates provided by the Oklahoma Department of Environmental Quality.

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Download DEQ Form 100-883 "Request for Transfer and Administrative Amendment of Permit" - Oklahoma

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Oklahoma Dept. Of Environmental Quality
AIR QUALITY DIVISION
Air Quality Division
ADMINISTRATIVE CHANGE NOTIFICATION
707 N Robinson, Suite 4100, P.O. Box 1677
Request for Transfer and Administrative Amendment of Permit
Oklahoma City, Oklahoma 73101-1677
FACILITY INFORMATION
Facility Name (Current)
Operating Permit No.
Legal Description
Section
Township
Range
Latitude (to 3 Decimals)
Longitude (to 3 Decimals)
UTM coordinates
Horizontal
Vertical
Zone
Physical Address or
Driving Directions
City or Nearest Town
County
Zip
INFORMATION UPDATE
INFORMATION ITEM
PREVIOUS/CURRENT (Transferor)
NEW (Transferee)
Facility Name
[Listed Above]
Company Name
(Owner/Operator)
Headquarters Mailing
Address
City
State
Zip
Responsible Official (Name)
Title
Phone
Fax
Email Address
Technical Contact (Name)
Title
Phone
Fax
Email Address
Effective Date of Transfer/Change(s):
Note: For a change of ownership or operational control, this date is the effective date for transfer of permit responsibility,
coverage, and liability between the current and new permittee.
TRANSFER CERTIFICATION
This notification has been submitted as required by OAC 252:100-7-2 or OAC 252:100-8-7.2. Based on information and belief formed
after reasonable inquiry, I certify that the statements and information contained in this notification are true, accurate, and complete,
and that this source is operating in compliance with its current permit and all applicable control rules.
CURRENT PERMITTEE
Responsible Official (signature)
Date
NEW PERMITTEE
Responsible Official (signature)
Date
DEQ F
# 100-883
A
O
10, 2007
ORM
DOPTED
CTOBER
Oklahoma Dept. Of Environmental Quality
AIR QUALITY DIVISION
Air Quality Division
ADMINISTRATIVE CHANGE NOTIFICATION
707 N Robinson, Suite 4100, P.O. Box 1677
Request for Transfer and Administrative Amendment of Permit
Oklahoma City, Oklahoma 73101-1677
FACILITY INFORMATION
Facility Name (Current)
Operating Permit No.
Legal Description
Section
Township
Range
Latitude (to 3 Decimals)
Longitude (to 3 Decimals)
UTM coordinates
Horizontal
Vertical
Zone
Physical Address or
Driving Directions
City or Nearest Town
County
Zip
INFORMATION UPDATE
INFORMATION ITEM
PREVIOUS/CURRENT (Transferor)
NEW (Transferee)
Facility Name
[Listed Above]
Company Name
(Owner/Operator)
Headquarters Mailing
Address
City
State
Zip
Responsible Official (Name)
Title
Phone
Fax
Email Address
Technical Contact (Name)
Title
Phone
Fax
Email Address
Effective Date of Transfer/Change(s):
Note: For a change of ownership or operational control, this date is the effective date for transfer of permit responsibility,
coverage, and liability between the current and new permittee.
TRANSFER CERTIFICATION
This notification has been submitted as required by OAC 252:100-7-2 or OAC 252:100-8-7.2. Based on information and belief formed
after reasonable inquiry, I certify that the statements and information contained in this notification are true, accurate, and complete,
and that this source is operating in compliance with its current permit and all applicable control rules.
CURRENT PERMITTEE
Responsible Official (signature)
Date
NEW PERMITTEE
Responsible Official (signature)
Date
DEQ F
# 100-883
A
O
10, 2007
ORM
DOPTED
CTOBER
Instructions for DEQ Form # 100-883
Administrative Changes
DEQ Form # 100-883 should be completed to notify AQD of an administrative change, such as a change in responsible official
(and associated information), or facility or company name. Complete the Facility Information section using the facility name as
listed prior to any change. [Note: DEQ Form #100-886 (Minor Source Relocation Application) must be used to request a
relocation permit.] If the administrative change (e.g. company name) affects multiple facilities, enter “Multiple Facilities – See
Attached List” on the first line, and include an attachment which lists the affected facilities and associated information.
Provide information for all items under the “PREVIOUS/CURRENT (Transferor)” column in the Information Update section.
Under the “NEW (Transferee)” column, provide information for all items that have change, and “N/C” or “No Change” for those
that have not changed. Provide the date on which change is or was effective. The form must be signed by the listed responsible
official. The definition of "Responsible Official" from OAC 252:100-3 is quoted below.
AQD will send a letter acknowledging receipt of the notification. For Part 70 (major) sources, this letter, as an attachment to the
listed permit, will serve as an administrative amendment to the permit, in accordance with OAC: 252:100-8-7.2(a). For minor
facilities, these administrative changes do not require a new permit. No fee is associated with this request.
Change of Owner/Operator
DEQ Form # 100-883 should also be used to notify AQD of a change of owner/operator of a facility and request transfer of
responsibility for an Air Quality Permit, in accordance with OAC 252:100-7-2 for minor facilities, and OAC 252:100-8-7.2 for
Part 70 (major) sources. This notification will also serve as a request for an administrative amendment under OAC 252:100-8-7.2.
Complete the information blocks as instructed above for administrative changes. If the change of owner/operator affects multiple
facilities, enter “Multiple Facilities – See Attached List” on the first line, and include an attachment which lists the affected
facilities and associated information. List the effective date for the transfer (see note on the form). For the purposes of OAC
252:100-8-7.2(a)(1)(D), the form may serve as a written agreement between the current and new permittee. It must be signed by
the responsible official listed for both of the parties. The definition of "Responsible Official," from OAC 252:100-3 is quoted
below. This notification must be submitted by the transferor within 30 days of the change of ownership.
AQD will send a letter acknowledging the change of owner/operator. For Part 70 (major) sources, this letter, as an attachment to
the listed permit, will serve as an administrative amendment to the permit, in accordance with OAC: 252:100-8-7.2(a). For minor
facilities, a change of facility owner/operator does not require a new permit. No fee is associated with this request.
Definition of "Responsible Official" Under OAC 252:100-3:
“‘Responsible Official’ means one of the following:
(A) For a corporation: a president, secretary, treasurer, or vice-president of the corporation in charge of a
principal business function, or any other person who performs similar policy or decision-making functions for
the corporation, or a duly authorized representative of such person if the representative is responsible for the
overall production, or operating facilities applying for or subject to a permit and either:
(i) The facilities employ more than 250 persons or have gross annual sales or expenditures exceeding
$25 million (in second quarter 1980 dollars); or
(ii) The delegation of authority to such representatives is approved in advance by the DEQ;
(B) For the partnership or sole proprietorship: a general partner or the proprietor, respectively;
(C) For a municipality, state, federal, or other public agency: Either a principal executive officer or ranking
elected official. For purposes of this Chapter, a principal executive officer or installation commander of a federal
agency includes the chief executive officer having responsibility for the overall operations of a principal
geographic unit of the agency (e.g., a Regional Administrator of EPA); or
(D) For affected sources:
(i) The designated representative insofar as actions, standards, requirements, or prohibitions under Title
IV of the Act or the regulations promulgated thereunder are concerned; and
(ii) The designated representative for any other purposes under this Chapter.”
[“Chapter” refers to OAC 252:100]
DEQ F
# 100-883
I
A
O
10, 2007
ORM
NSTRUCTIONS
DOPTED
CTOBER
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