SCP-01: Submittal cover page Permit application/notification/ determination request fee submittal Air Quality Permit Program Doc Type: Permit Application Instructions on page 6. 1a) AQ Facility ID number: 1b) Agency Interest ID number: 2) Facility name: 3) Submittal is (choose from the following options and then complete the remainder of item 3 as directed): The final certified (or recertified) version of a previously-submitted permit application. Complete Section 3A. Additional or supplemental information requested by permit staff during the permit-writing process. Complete Section 3A. A request that the Minnesota Pollution Control Agency (MPCA) make an applicability determination. Complete Section 3A. An application for a new Individual Part 70 or State Permit – Complete Section 3B: An application for reissuance of an Individual Part 70 or State Permit – Complete Section 3B. Note: Applications for reissuance must be submitted using the MPCA’s e-Services website at https://www.pca.state.mn.us/data/e-services. Applications outside of the e-services website will only be accepted if there is a request for confidentiality. An application for an amendment to an existing Individual Part 70 or State Permit – Complete Section 3B. An application for a Registration Permit, Capped Permit, or General Permit – Complete Section 3C. An application for an administrative change to an existing Registration, Capped, or General Permit – Complete Section 3C. A notification required under Minn. R. 7007.1150(C); Minn. R. 7007.1250, subp. 4; Minn. R. 7007.1350; Minn. R. 7007.0800, subp. 10, item B. Complete Section 3D. A notification from a hot mix asphalt plant holding a Registration Permit of the intent to incorporate ground tear-off shingles and/or manufacturer scrap shingles in the hot mix asphalt. Complete Section 3D. Section 3A – Request for applicability determination, recertification of a previouslysubmitted permit application, or supplement to a previously-submitted permit application Use this section only if your submittal is one of the following:  The final version of a previously submitted permit application, incorporating changes negotiated through the permitting process, or  Submittal of additional or supplemental information requested by permit staff during the permit-writing process, or  A request for the MPCA to make an applicability determination. For final versions and supplemental information, enter the “tracking number” which can be obtained from the MPCA permit staff working on the permit. Check one of the boxes below. Do not complete Sections 3B, 3C, or 3D. Continue with item 4 of the form. Choose one of the following: Quantity Points Total points Recertification of a previously-submitted permit application – tracking number: NA NA NA Supplement to a previously-submitted permit application – tracking number: NA NA NA An Applicability Determination Request https://www.pca.state.mn.us aq-f1-scp01 • 3/7/22 • 651-296-6300 x 10 = • 800-657-3864 • Use your preferred relay service • Available in alternative formats Page 1 of 9 Section 3B – Application for an Individual Part 70 or State Permit, reissuance of an Individual Part 70 or State Permit, or amendment of an Individual Part 70 or State Permit Choose one of the following: This is the original application or replacement for a denied or withdrawn application. Complete the table below. This is the replacement for an application returned as incomplete (not denied) and the scope is exactly the same as in the incomplete application. Enter the tracking number of the incomplete application being replaced: . A new fee is not required, so completion of the table below is not necessary. This is the replacement for an application returned as incomplete (not denied) and the scope is different than the incomplete application. Enter the tracking number of the incomplete application being replaced: . Complete the table below. If your submittal includes notifications that do not require a permit application, also complete Section 3D. Choose one of the following: Quantity Points Application for an Individual Part 70 Permit x 75 = Application for an Individual State Permit x 50 = Total points Application for reissuance of an expiring Individual Part 70 or State Permit (does not include modifications to a permit that require an amendment) Note: Applications outside of the e-services website will only be accepted if there is a request for confiden

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