Southern Ute Indian Tribe

Title V Permit Application and Compliance Forms

The following forms are used to prepare Title V permit applications, and subsequently, to submit other required information, certify compliance, and pay fees. The forms are provided in two formats: Adobe Acrobat (PDF) and Microsoft Word (DOC). The Air Program respectfully requests that all Title V permitting and compliance forms be submitted electronically via email.

  • Attach all Microsoft Word and PDF forms as a PDF file.
  • Attach all Microsoft Excel forms as a live electronic Excel file.
  • Signed Certifications of Truth, Accuracy, and Completeness (CTAC) may also be scanned and emailed as an attachment

Email all forms to: airquality@southernute-nsn.gov

PERMIT APPLICATION FORMS
General Information and Summary (GIS)PDF
Emission Unit Description for Internal Combustion Sources (EUD-1)PDF
Emission Unit Description for External Combustion Sources (EUD-2)PDF
Emission Unit Description for Dehydration Units (EUD-3)PDF
Emission Unit Description for Process Sources (EUD-4)PDF
Emission Unit Description for VOC Emitting Sources (EUD-5)PDF
Insignificant Emissions (IE)PDF
Emission Calculations (EMISS)PDF
Potential to Emit Summary (PTE)PDF
Initial Fee Calculation Worksheet (FEE)XLSX
Initial Compliance Plan & Compliance Certification (I-COMP)PDF
Certification of Truth, Accuracy, and Completeness (CTAC)PDF
COMPLIANCE FORMS
Certification of Truth, Accuracy, and Completeness (CTAC)PDF
2019 Annual Fee Calculation Worksheet (FEE)XLSX