Fill - Free fillable Facility Name And Naics Code Change Form (Bay Area Air Quality Management District) PDF form

BAY AREA AIR QUALITY MANAGEMENT DISTRICT

FACILITY NAME & NAICS CODE CHANGE FORM

Name change allowed if the owning entity of the facility does not change

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



 Iftheowningentity(ownership)haschangedforthefacility,usetheTransferofOwnershipFormandreadthe

instructionsforthatform.



1. Purposeforsubmittingthisform



Thisformisbeingsubmittedto:(Checkallthatapply)

Updatefacilityname(CompleteParts2,3,4and6)

UpdateNorthAmericanIndustryClassificationSystemCode(CompleteParts2,5and6)

2. CurrentFacilityIdentification–Enterinformationasitcurrentlyappearsonyourpermit.



CurrentFacilityName BAAQMDFacilityID

 



3. NewFacilityName



NewFacilityName



4. OwningEntityConfirmation

Thefacilitynamechangeabovedoesnotaffectthecurrentowningentityforthefacility.

 Checkifyouagreewiththisstatement.



5. Facility’sPrimaryNorthAmericanIndustryClassificationSystemCode



NAICSCode(6digits)



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 Name & NAICS Change Form

Introduction

Use the following instructions to help guide you through the Facility Name Change

form.

Who should use

this form?

This form is for existing facilities, currently permitted by the Bay Area Air Quality

Management District that would like to update the facility name or the NAICS code for

the facility.

 If the owning entity (ownership) has changed for the facility, do NOT use this

form. Use the Transfer of Ownership Form and read the instructions for that

form.

Current Facility

Identification

Current Facility Name – Enter the name as it currently appears on the BAAQMD permit

or invoice.

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

BAAQMD.

Owning Entity &

Type of

Business

Owning Entity - 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.

North American

Industry

Classification

System code

North American Industry Classification System (NAICS) is the standard used by Federal

statistical agencies in classifying business establishments for the purpose of collecting,

analyzing, and publishing statistical data related to the U.S. business economy. This

code represents the primary operation of your business, NOT the primary device

permitted by BAAQMD.

Below are common NAICS codes:

811121

Automotive Body, Paint, and Interior Repair and Maintenance

812320

Dry Cleaning and Laundry Services (except Coin‐Operated)

447110

Gas dispensing facility with Convenience Stores

447190

Gas dispensing facility without Convenience Stores

Still need help?

Call the Engineering Division at (415) 749-4990.

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Facility Name And Naics Code Change Form (Bay Area Air Quality Management District)

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