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Clean Air Act Annual Compliance Certification
Annual certification submitted by Title V permit holders certifying compliance or noncompliance with all permit terms and conditions.
PDF TemplateUse the instructions below to complete this form
Instructions
Certify the compliance status of each emission unit and applicable requirement in your Title V permit. Identify any deviations from permit conditions that occurred during the reporting period, including the duration and cause. Describe corrective actions taken. The certification must be signed by a responsible official under penalty of perjury. Submit to both the state permitting authority and the EPA Regional Administrator within 30 days of the end of the reporting period.