This form can be used for notifying the Department of the relocation of portable air emission sources and industrial storm water dischargers. Portable facilities that are subject to the Air Program requirements and/or National Pollutant Discharge Elimination System (NPDES) Industrial Storm Water Permits will need to use this form.
This notification form is to be submitted 20 days prior to a proposed relocation. Relocation Notices are subject to review and proposed relocation sites may be rejected based upon air quality (NDEE Title 129 Chapter 6) or water quality (NPDES Permit #NER920000, Section 1.8) concerns.
Questions concerning this form should be directed either to the Air Quality Section at 402-471-2189 or the main line at 402-471-2186.
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.
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