Submit signed form online at www.mdeq.ms.gov/rmcgp or via hard copy to Air II Branch Manager, Environmental Permits Division,
MDEQ, PO Box 2261, Jackson, MS 39225
NOTIFICATION OF CONSTRUCTION AIR FORM
READY-MIX CONCRETE GENERAL PERMIT
COVERAGE NUMBER MSG11__ __ __ __
Instructions: This form should be completed and submitted for the following construction milestones for both initial
construction of a facility as well as a major modification to a facility (as defined in ACT 7, Condition T-9 of the general permit).
The deadlines for submitting this form, as specified in ACT 3, Condition S-1 of the general permit, are as follows:
• Part A – Notification of Start of Construction: Within 15 days after beginning actual construction.
• Part B – Notification of Completion of Construction: Prior to startup of the facility or modified equipment.
• Part C – Notification of Suspension of Construction: Within 18 months of obtaining coverage or last performing a
construction activity, whichever is later.
Parts A and B may be completed on the same form if both deadlines specified above can be met. Mark each section that
applies.
Company Name: Facility Name:
Facility Street Address: City: County:
Contact Person:
Phone No.:
Email:
Mailing Address:
City:
State:
Zip:
Is or will this facility be a Synthetic Minor source upon startup (i.e., max. capacity exceeds 150 yd
3
/hr)?
☐ Yes ☐ No
PART A – NOTIFICATION OF START OF CONSTRUCTION
Construction / Major Modification of facility’s air emissions sources began on: (DATE)
PART B – NOTIFICATION OF COMPLETION OF CONSTRUCTION
Construction / Major Modification of facility’s air emissions sources was completed on: (DATE)
PART C – NOTIFICATION OF SUSPENSION OF CONSTRUCTION
Construction / Major Modification of facility’s air emissions sources was suspended on: (DATE)
Based on my inquiry of the person or persons responsible for gathering the information, the information submitted is, to the
best of my knowledge and belief, true, accurate and complete.
Authorized Signature of Responsible Official Date
Printed Name Title
*A responsible official must be a corporate officer or facility manager delegated authorization to sign documents.
