Application – Operating Permit – Form 1.0 – General Information
This information is provided by the Nebraska Department of Environment and Energy to assist the public and regulated community.
Form #: 08-201 Applications and Forms Revised: 9/30/22
SizeFile Name
76 KB Form_1.0_General_Instructions.pdf
68 KB Form_1.0_General_Instructions.docx
84 KB Form_1.0_Section_1.1_Checklist.pdf
94 KB Form_1.0_Section 1.1_Checklist.docx
131 KB Form_1.0_Section_1.1_Checklist_Instructions.pdf
64 KB Form_1.0_Section_1.1_Checklist_Instructions.docx
105 KB Form_1.0_Section_1.2_Administrative_Information_and_Certification.pdf
90 KB Form_1.0_Section_1.2_Administrative_Information_and_Certification.docx
96 KB Form_1.0_Section_1.2_Administrative_Information_and_Certification_Instructions.pdf
77 KB Form_1.0_Section_1.2_Administrative_Information_and_Certification_Instructions.docx
99 KB Form_1.0_Section_1.3_Insignificant_Activities.docx
155 KB Form_1.0_Section_1.3 Insignificant_Activities.pdf
68 KB Form_1.0_Section_1.4_Permit_Shield.pdf
66 KB Form_1.0_Section_1.4_Permit_Shield.docx


Section 1.1 Checklist
All facilities submitting an air quality operating permit application must complete Section 1.1.
Section 1.2 Administrative Information & Certification
All facilities submitting an air quality operating permit application must complete Section 1.2.
Section 1.3 Insignificant Activities
Insignificant activities are those activities and/or emissions units that may be excluded from inclusion in operating permit applications or if included in the application, excluded from emissions inventories.

All sources should utilize the instructions within Section 1.3, Insignificant Activities to determine which activities at their facility are insignificant and whether the items should be included in Section 1.3 Insignificant Activities List.
Section 1.4 Permit Shields
Complete Section 1.4 if you are a Class I source applying for a permit shield. A Class I source can request a permit shield in its operating permit application for both those requirements that are applicable and those requirements that appear to be applicable but are not applicable to the source, according to Title 129 – Nebraska Air Quality Regulations, Chapter 8, Section 014. For more information concerning permit shields, please read the Permit Shields Fact Sheet.

Note: Effective Oct. 1, 2009, any individual submitting any application or form that would derive public benefit from the state must also fill out a United States Citizenship Attestation form. This applies to individuals submitting the forms on their own behalf. If applicable, please fill out the United States Citizenship Attestation form below and submit it with the relevant applications and forms.

United States Citizenship Attestation Form

This Complete Form is only available as an Adobe Acrobat (PDF) file.
File size is 97 KB