Revised 24Jan19
Maricopa County
Air Quality Department
Return completed form to:
Maricopa County Air Quality Department
3800 N Central Ave, Suite 1400, Phoenix, AZ 85012
Phone (602) 506-6010 Fax (602) 372-0587
AQPermits@maricopa.gov
Documents may be submitted in person at:
3800 N. Central Ave. Suite 1400, Phoenix, AZ 85012 or 501 N. 44th Street, Suite 200, Phoenix, AZ 85008.
DUST CONTROL PLAN CHANGE
Permit Number: Permit Holder:
Date:
Project Name:
Project Address: City: State: Zip:
Reason for plan change:
Sections changed (including page # and section name):
1.
2.
3.
4.
5.
SPECIAL INSTRUCTIONS
Attach the revised dust control plan and a new site plan if necessary.
Certification by the permit holder: I certify that the information provided in this application and accompanying documents is true, correct
and complete to the best of my knowledge.
Signature: Title:
Email: Date:
OFFICE USE ONLY
Approved By: Date:
Important: Please note that email will be our primary means for routine communication with you, unless you do not have an
email account. Please be sure that your email address is entered correctly.
