Air emissions shutdown/breakdown form

The air emissions breakdown/shutdown notification form below is required by Minnesota State Law (7019.1000) to prevent endangerment to human health or the environment.

The owner or operator of an emission facility, emissions unit, or stationary source shall notify the Minnesota Pollution Control Agency (MPCA) commissioner within 24 hours of a breakdown of more than one-hour duration of any control equipment or process equipment if the breakdown causes any increase in the emissions of any regulated air pollutant. Shutdown notification is similarly required, by the owner or operator of an emission facility, emission unit, or stationary source at least 24 hours in advance of a planned shutdown, of any duration, if the shutdown causes any increase in the emissions of any regulated air pollutant. However, if the owner or operator does not have advance knowledge of the shutdown, notification shall be made to the commissioner as soon as possible after the shutdown. Note that the owner or operator is also required to notify the MPCA when the shutdown or breakdown event is over.

There are two forms to choose from:

  1. Initial event report. Use the form, located at the bottom of page, to report an event that has either already occurred and concluded, or is currently occurring and has not concluded.  
  2. Update the event report. Choose this form to amend an initial event report to add the event conclusion date and time.

You have two options for using the online forms below:

  1. Submit the completed form electronically by pressing the "Submit" button at the bottom of the form.
  2. After submitting the form, you will receive an immediate, automated email reply that summarizes what you submitted to the MPCA. If submitting an initial event report, the reply will include an Incident Number that you'll need to keep to reference any future updates to this report. This incident number is required to use the Update Event Report form.
  3. Mail or fax in the completed form by printing the page instead of submitting the form electronically. Mail or fax your completed form to the Minnesota Pollution Control, 520 Lafayette Rd, St Paul MN 55155, Attention Compliance Tracking Coordinator, Industrial Division, 5th Floor.

If you do not want to use the online forms, you may complete the MS Word versions of these forms and mail or fax it to the MPCA at the address or fax number noted in option #2 above, or email to

For assistance, call the MPCA at 651-296-6300 or 800-657-3864.

Before you use the form below, please note:

  • You must be 13 years of age or older to use this form. If you are younger than 13, please ask a parent to fill out this form for you. MPCA Privacy Policy.