Pinal County, AZ · Pinal County
Air Quality Permit Cancellation Request Form
This form lets a company or facility representative request cancellation of a Pinal County air quality permit.
At a glance
- Issued by
- City of Pinal County · Pinal County, Pinal County, Arizona
- Notarization
- Not required: file this form without a notary.
- Official source
- pinal.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
The form requests cancellation of an air quality permit when a facility has permanently closed, emission units have been removed or dismantled, or the facility no longer needs a permit. It asks for company and facility details, the permit number, a cancellation reason and requested effective date, and a responsible official’s certification, printed name, title, signature, and date.
Who needs it
A company or facility’s responsible official can use this form to request cancellation of its Pinal County air quality permit.
How to submit it
Submit it to the county department named on the form; check the county website for current contact details.
About notarization
This form is signed and dated without a notary; it lists no notarized attachment or related sworn step.
How to submit this form
- 1
Download the Form
Download the Air Quality Permit Cancellation Request Form.
- 2
Complete the Form
Enter the company and facility information, permit number, cancellation reason, and requested cancellation date.
- 3
Sign and Date
Have the responsible official provide their printed name, title, signature, and date, and complete the certification.
- 4
Submit to the County
Submit the completed form to the county department named on it; check the county website for current contact details.
Frequently asked questions
- What does the Air Quality Permit Cancellation Request Form do?
- It lets a company or facility request cancellation of an air quality permit and certify that the facility no longer needs the permit or has ceased permitted operations.
- Who signs the permit cancellation request?
- A responsible official provides their printed name, title, signature, and date, and certifies the information and facility status described on the form.
- Do I need a notary for the Air Quality Permit Cancellation Request Form?
- No. The form has a signature and date field but no notary block; it lists no notarized attachment or related sworn step.
- How do I submit the permit cancellation request?
- Submit it to the county department named on the form. The form does not give submission details, so check the county website for current contact information.