BAY AREA AIR QUALITY MANAGEMENT DISTRICT
FACILITY CONTACTS FORM
For new information on and updates to facility contacts
All fields are required unless otherwise noted. Please type or print.
Mail to:
BAAQMD
Engineering Division
375 Beale St.
, Suite 600
San Francisco, CA 94105
Tel:(415) 749-4990
Page1of2 Anelectronicversionofthisformandinstructionscanbefoundatwww.baaqmd.gov. v05/2016
1. Purposeofsubmittingthisform
Thisformisbeingsubmittedto:
(Selectone)
Provideinformationonfacilitycontactsforanewfacility.
(Completeallsections)
Updateinformationoncurrentfacilitycontacts
(CompleteParts1,2,6andapplicablecontactsections)
2. FacilityName
FacilityName BAAQMD FacilityID(exceptnewfacilities)
3. OwnerContact
FirstName LastName
BusinessNameofContact(Ifdifferentfromfacility) ContactTitle
AddressLine1 AddressLine2(Optional)
City State ZipCode
EmailAddress
PrimaryPhone(xxxxxxxxxx) AlternatePhone(optional) FaxNumber(Optional)

4. OperatorContactSelectexistingcontactorfilloutinformationbelow.
SameasOwnerContact
FirstName LastName
BusinessNameofContact(Ifdifferentfromfacility) ContactTitle
AddressLine1 AddressLine2(Optional)
City State ZipCode
EmailAddress
PrimaryPhone(xxxxxxxxxx) AlternatePhone(optional) FaxNumber(Optional)


BAY AREA AIR QUALITY MANAGEMENT DISTRICT
FACILITY CONTACTS FORM
For new information on and updates to facility contacts
All fields are required unless otherwise noted. Please type or print.
Mail to:
BAAQMD
Engineering Division
375 Beale St., Suite 600
San Francisco, CA 94105
Tel:(415) 749-4990
Page2of2 Anelectronicversionofthisformandinstructionscanbefoundatwww.baaqmd.gov. v05/2016
5. BillingContact‐Selectexistingcontactorfilloutinformationbelow.
SameasOwnerContact SameasOperatorContact
FirstName LastName
BusinessNameofContact(Ifdifferentfromfacility) ContactTitle
AddressLine1 AddressLine2(Optional)
City State ZipCode
EmailAddress
PrimaryPhone(xxxxxxxxxx) AlternatePhone(optional) FaxNumber(Optional)

6. Certification/Signatureofpersonresponsiblefortheinformationonthisform.
IherebycertifythatIamauthorizedtocompletethisformforthefacilityandthatallinformationcontainedhereinistrue
andcorrect.
Name Title
Signature Date Phone(xxxxxxxxxx)
BAYAREAAIRQUALITYMANAGEMENTDISTRICT
BAAQMD
EngineeringDivision
375BealeSt.,Suite 600
SanFrancisco,CA94105
Page1of1 v05/2016
Instructions:FacilityContactsForm
Introduction UsethefollowinginstructionstohelpguideyouthroughtheFacilityContactsform.
BayAre
aAirQualityManagementDistrict’snewcomputersystemrequiresallfacilities
havethreecontacts;ownercontact,operatorcontactandbillingcontact.Ifyouarean
existingfacility,untilyourcontactsareupdated,yourcurrentsitecontactwillbeused
asallthreecontacts.
Whoshoulduse
thisform?
Thisformisfor:
Newfacilitiesthathavenocontactsassociatedwiththeirfacility.AFacility
Creation&Updateformmustalsobesubmitted.
Existingfacilitiesthatneedtoupdateinformationoncontactsalready
associatedwiththefacility.
BAAQMDID FacilityName–EnterthenameasitappearsontheBAAQMDpermitorinvoice.
BAAQMDFacilityID‐ThefacilityIDisavailableonthepermitorinvoiceissuedby
BAAQMD.
ContactTypes OwnerContact–The individualrepresentingtheowner.Theowneristheindividual,
partnership,limitedliabilitycompany,corporation,orotherentitythatownsor
controlsthepermittedequipmentandisresponsibleforthepermittooperate.
OperatorContact–Theindividualresponsiblefordaytodayoperationsand/orair
qualityissuesatthefacility.
BillingContact–Theindividualresponsibleforpayinginvoices(accountsreceivable).
ThisindividualisthedefaultcontacttoreceiveallinvoicesfromBAAQMD.
EMailAddress BAAQMDisworkingonasystemwithonlinefeaturesandincreasedcommunication
throughe‐mail.Pleaseprovidee‐mailaddress(es),sothatwecaninformyouwhenthe
systemisavailable.
Stillneedhelp? CalltheEngineeringDivisionat(415)749‐4990.