Form 4530-133 "Facility Requirements - Compliance Plan and Schedule - Air Pollution Control Permit Application" - Wisconsin

What Is Form 4530-133?

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

Form Details:

  • Released on August 1, 2020;
  • The latest edition provided by the Wisconsin Department of Natural Resources;
  • 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 fillable version of Form 4530-133 by clicking the link below or browse more documents and templates provided by the Wisconsin Department of Natural Resources.

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Download Form 4530-133 "Facility Requirements - Compliance Plan and Schedule - Air Pollution Control Permit Application" - Wisconsin

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State of Wisconsin
Facility Requirements - Compliance Plan And Schedule
Department of Natural Resources
Air Pollution Control Permit Application
dnr.wi.gov
Information attached?
Y
N
Form 4530-133 (R 08/20)
SEE INSTRUCTIONS ON
REVERSE SIDE
1. Facility name:
2. Facility identification number:
3. For facilities presently in compliance with all applicable requirements, complete the following:
We will continue to operate and maintain this facility in compliance with all applicable requirements.
Form 4530-132 identifies new requirements that apply or will apply to this facility during the term of the permit. We will meet
such requirements on a timely basis.
4. For facilities not presently in compliance with all applicable requirements, complete the following.
This facility is in compliance with all applicable requirements except for those indicated below. We will achieve compliance
according to the following schedule:
Applicable Requirement
Corrective Actions
Deadline
1.
2.
3.
4.
Progress reports will be submitted:
Start date:
and every six (6) months thereafter
Page 1 of 2
State of Wisconsin
Facility Requirements - Compliance Plan And Schedule
Department of Natural Resources
Air Pollution Control Permit Application
dnr.wi.gov
Information attached?
Y
N
Form 4530-133 (R 08/20)
SEE INSTRUCTIONS ON
REVERSE SIDE
1. Facility name:
2. Facility identification number:
3. For facilities presently in compliance with all applicable requirements, complete the following:
We will continue to operate and maintain this facility in compliance with all applicable requirements.
Form 4530-132 identifies new requirements that apply or will apply to this facility during the term of the permit. We will meet
such requirements on a timely basis.
4. For facilities not presently in compliance with all applicable requirements, complete the following.
This facility is in compliance with all applicable requirements except for those indicated below. We will achieve compliance
according to the following schedule:
Applicable Requirement
Corrective Actions
Deadline
1.
2.
3.
4.
Progress reports will be submitted:
Start date:
and every six (6) months thereafter
Page 1 of 2
Facility Requirements Compliance Plan
Commitments And Schedule
Air Pollution Control Permit Application
Completion of this form is required by ss. NR 407.05(4)(h) and (8), Wis. Adm. Code for all operation permit applications filed pursuant
to s. 285.61, 285.62 and 285.66, Wis. Stats., except initial applications for existing, non-Part 70 sources and initial applications for new
or modified sources for which no construction permit is required. The department will not consider or act upon an application unless the
form is submitted and complete (when applicable). Any personal information collected will be used for administrative purposes only
and may be provided to requesters to the extent required by Wisconsin's Open Records Law [ss. 19.31-19.39, Wis. Stats.]
Items 1 and 2
Provide the facility name and identification (FID) number from the Department’s Emissions Inventory.
Item 3
All operation permit applications except initial applications for existing, non-Part 70 sources and initial applications
for new or modified sources for which no construction permit is required must include the two statements shown in
Item 3. Mark each box to include each statement in your application and to meet the requirements of s. NR
407.05(4)(h), Wis. Adm. Code.
Item 4
For each applicable requirement with which the facility is not in compliance identified on Form 4530-132, describe
how compliance will be achieved in the corrective actions column. Include equipment or operational changes
necessary to come into compliance. Refer to orders, judgments, approved plans or other documents that establish or
more fully describe how applicable requirements will be met. Form 4530-135 may be used to provide additional
explanation.
Summarize the schedule of measures leading to compliance with all requirements. Include remedial measures and
deadlines for milestone events (e.g. contract award date, start dates for construction or installation, completion of
operator training). Reference any orders, decrees or other judgments that establish or more fully describe the
compliance schedule.
Summarize the schedule for submission of progress reports. Refer to appropriate documents that establish or more
fully describe the submission schedule. The start date for these progress reports must be no later than 6 months
following the date of this permit application.
Form 4530-133 (R 08/20)
Page 2 of 2
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