Environmental Justice Summary Supplemental Information for Air Quality Regulation 3
Air Pollution Control Division

Background: Under Colorado’s Air Quality Regulation 3, an Environmental Justice Summary (“EJ Summary”) is required for all applicable permit applications. This EJ Summary consists of:
  1. Environmental Justice Report (“EJ Report” - submitted separately as an email attachment to cdphe_apcd_ejreports@state.co.us).
  2. Environmental Justice Summary Supplemental Information Form (this form).
  3. Any additional supporting documentation (such as map images).
You must submit a complete EJ Summary to the Air Pollution Control Division (APCD) for review and approval before submitting your main permit application. You will then receive a letter of concurrence from the Division’s Environmental Justice in Permitting Specialist. The Environmental Justice Summary, including the Environmental Justice Report, is part of the permit record. If the main permit application does not include a letter of concurrence, it may be rejected as incomplete.

Additional information is available on the EJ Report Tool website and the Guidance for Small Businesses website.

Note: If a modeling determination (form APCD-114) is required for this emission source, you should submit your modeling determination request at the same time you submit the Environmental Justice Summary by following the instructions on form APCD-114. If you are unsure whether a modeling determination is required for this emission source, please consult the Air Pollution Control Division’s website.

Note: Small businesses can contact the Air Pollution Control Division's Small Business Assistance Program for assistance: cdphe_apcd_sbap@state.co.us. For information about which businesses qualify for assistance as a small business, visit the program's website.

A copy of your responses will be emailed to you upon form submission.
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Email *
Section 1: Background Information (Company/Facility)
Company name *
Facility name (If the facility does not have a name, enter the company name.)
 *
Facility latitude (This can be found in the EJ Report.) *
Facility longitude (This can be found in the EJ Report.) *
Facility address
Census block group(s) in which the facility is located (this information is found in the facility’s Environmental Justice Report)
 *
Which type of air permit will you be applying for? *
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