Notice of Permit Register Entry Form

This form is not for general public use but is intended for Ecology and other permitting agencies.

Use this form to electronically submit Permit Register Entries.

Please provide the following information:

Agency:
Agency Contact:
Permit Type:
Codes:
Permit Applicant:
Physical Address:
Physical Address Zip:
Mail Address:	If different from above
Zip Code:
Facility Description:
Actual ANNUAL emission reported in the emission inventory for calendar year:
Total Particulates: Tons Per Year (TPY):
CO: TPY
NO_x: TPY
SO₂: TPY
PM_10: TPY
VOCs:TPY
Other pollutant:
Comment Period:
Comment Period Contact:	If different from above
Public Hearing:
Date - Time:
Location:
If this is a permit modification describe:
Date of Determination:
For information on this form, please contact:
* Email Address:	* REQUIRED FIELD Form will not submit without your valid email address
Approximate Time Submitted:
Date Submitted:

Electronic Submittal Version of 020-8 (03/23)