Fill - Free fillable Facility Contacts Form And Instructions (Bay Area Air Quality Management District) PDF form

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

Page1of2 Anelectronicversionofthisformandinstructionscanbefoundatwww.baaqmd.gov. v05/2016



1. Purposeofsubmittingthisform



Thisformisbeingsubmittedto:

(Selectone)

Provideinformationonfacilitycontactsforanewfacility.

(Completeallsections)

Updateinformationoncurrentfacilitycontacts

(CompleteParts1,2,6andapplicablecontactsections)

2. FacilityName



FacilityName BAAQMD FacilityID(exceptnewfacilities)



3. OwnerContact



FirstName LastName



BusinessNameofContact(Ifdifferentfromfacility) ContactTitle



AddressLine1 AddressLine2(Optional)



City State ZipCode

 

E‐mailAddress



PrimaryPhone(xxx‐xxx‐xxxx) AlternatePhone(optional) FaxNumber(Optional)





4. OperatorContact–Selectexistingcontactorfilloutinformationbelow.



SameasOwnerContact



FirstName LastName



BusinessNameofContact(Ifdifferentfromfacility) ContactTitle



AddressLine1 AddressLine2(Optional)



City State ZipCode

 

E‐mailAddress



PrimaryPhone(xxx‐xxx‐xxxx) AlternatePhone(optional) FaxNumber(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

Page2of2 Anelectronicversionofthisformandinstructionscanbefoundatwww.baaqmd.gov. v05/2016 



5. BillingContact‐Selectexistingcontactorfilloutinformationbelow.



 SameasOwnerContact SameasOperatorContact



FirstName LastName



BusinessNameofContact(Ifdifferentfromfacility) ContactTitle



AddressLine1 AddressLine2(Optional)



City State ZipCode

 

E‐mailAddress



PrimaryPhone(xxx‐xxx‐xxxx) AlternatePhone(optional) FaxNumber(Optional)





6. Certification/Signatureofpersonresponsiblefortheinformationonthisform.

IherebycertifythatIamauthorizedtocompletethisformforthefacilityandthatallinformationcontainedhereinistrue

andcorrect.

Name Title



Signature Date Phone(xxx‐xxx‐xxxx)

 



BAYAREAAIRQUALITYMANAGEMENTDISTRICT

BAAQMD

EngineeringDivision

375BealeSt.,Suite 600

SanFrancisco,CA94105



Page1of1  v05/2016

Instructions:FacilityContactsForm



Introduction UsethefollowinginstructionstohelpguideyouthroughtheFacilityContactsform.



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.



Whoshoulduse

thisform?

Thisformisfor:

 Newfacilitiesthathavenocontactsassociatedwiththeirfacility.AFacility

Creation&Updateformmustalsobesubmitted.

 Existingfacilitiesthatneedtoupdateinformationoncontactsalready

associatedwiththefacility.



BAAQMDID FacilityName–EnterthenameasitappearsontheBAAQMDpermitorinvoice.

BAAQMDFacilityID‐ThefacilityIDisavailableonthepermitorinvoiceissuedby

BAAQMD.



ContactTypes OwnerContact–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.

OperatorContact–Theindividualresponsiblefordaytodayoperationsand/orair

qualityissuesatthefacility.

BillingContact–Theindividualresponsibleforpayinginvoices(accountsreceivable).

ThisindividualisthedefaultcontacttoreceiveallinvoicesfromBAAQMD.



E‐MailAddress 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.



Stillneedhelp? CalltheEngineeringDivisionat(415)749‐4990.



Download
Save PDF to desktop

Email
Email completed PDF

Send for Signing
Email for others to sign

Print
Print document

NAME

Facility Contacts Form And Instructions (Bay Area Air Quality Management District)

View Audit Log
Print With Audit Log
Duplicate Document

Fill Online, Printable, Fillable, Blank Facility Contacts Form And Instructions (Bay Area Air Quality Management District) Form

Related forms

Fillable Facility Contacts Form And Instructions (Bay Area Air Quality Management District)

Fill Online, Printable, Fillable, Blank Facility Contacts Form And Instructions (Bay Area Air Quality Management District) Form

Related forms

First 20 documents completely FREE!