South Coast Air Quality Management District, Form 200-B (2016.05)
Mail To:
SCAQMD - Permit Services
P.O. Box 4944
Diamond Bar, CA 91765-0944
Tel: (909) 396-3385
www.aqmd.gov
South Coast Air Quality Management District
Form 200-B
Address Update/Correction
Section A - Operator Information
1. Facility Name (Business Name of Operator As It Appears On The Permit): 2. Valid AQMD Facility ID (Available On Permit Or Invoice Issued
By SCAQMD):
Section E - Authorization/Signature
I hereby certify that all information contained herein and information submitted with this application are true and correct.
9. Signature of Responsible Official: 10. Title of Responsible Official:
11. Print Name: 12. Date:
13. Phone #: 14. Fax #:
Section D - Location Address Update/Correction
This section of the form is NOT to be used for physical relocation of permitted equipment.
You must obtain a new permit for each equipment that has been moved to a new location.
For a new permit, submit Form 400-A, Form 400-CEQA, equipment supplemental form
and appropriate fees for each equipment.
This section of the form is to be used for a location address change made by the city, county, post office or other
agency due to rezoning, renaming or renumbering of the street address, etc. Include a copy of the notification from
the agency regarding the address change.
Note: All SCAQMD permits at this facility must be reissued with the new location address. The reissue fee is listed in
SCAQMD Rule 301(f)(2). For a reissued Title V or RECLAIM permit, please submit Form 400-A and the fee for
Administrative Permit Revision together with this form. (For fees, see SCAQMD Rule 301(l), (m) or (n).)
7. Old Location Address: 8. New Location Address:
Street Address Street Address
, ,
City State Zip City State Zip
Section C - Permit Mailing Address Update/Correction
5. Old Permit Mailing Address: 6. New Permit Mailing Address:
Address Address
, ,
City State Zip City State Zip
Section B - Billing Mailing Address Update/Correction
3. Old Billing Mailing Address: 4. New Billing Mailing Address:
Address Address
, ,
City State Zip City State Zip
CA
CA
