South Coast Air Quality Management District, Form 400-CO (2016.02)
Mail To:
SCAQMD
P.O. Box 4944
Diamond Bar, CA 91765-0944
Tel: (909) 396-3385
www.aqmd.gov
South Coast Air Quality Management District
Form 400-CO
Application For Change Of Operator
Note 1: A Change Of Operator Permit can only be
issued if ALL
of the following conditions apply:
Note 2: Submit one form for each application/permit.
The existing permit is still active
or can be reinstated to an active status;
The equipment is operated at the same location as listed in the existing permit; AND
All fees due by previous operator must be paid.
AQMD
USE ONLY
APPLICATION TRACKING # TYPE
B C
EQUIPMENT CATEGORY CODE: FEE SCHEDULE:
$
VALIDATION
ENG. A R
DATE
ENG. A R
DATE
CLASS
I III
ASSIGNMENT
Unit Engineer
CHECK/MONEY ORDER
#
TRACKING # AMOUNT
$
Section A - Previous Operator Information
1. Business Name of Operator As It Appears On The Permit: 2. Current AQMD Facility ID (Available On Permit Or Invoice Issued By AQMD):
Section B - New Operator Information
3. Business Name of Operator As It Should Appear On The Permit:
4. Owner’s Business Name (If different from Business Name of Operator):
Section C - Equipment Location Address Section D - Permit Mailing Address
5. Fixed Location Various Location
(For equipment operated at various locations, provide address of initial site.)
Street Address
, CA
City State Zip
Contact Name Title
Phone # Ext. Fax #
E-Mail
6. Permit and Correspondence Information:
Check here if same as equipment location address
Address
,
City State Zip
Contact Name Title
Phone # Ext. Fax #
E-Mail
Section E - Facility Business Information
7. What business is conducted at this location? 8. What is your primary NAICS Code (North American Industrial
Classification System)?
9. Ar
e you a small business as per AQMD’s Rule 102 definition? No Yes
(10 employees or less and total gross receipts are $500,000 or less or a not-for-profit training center)
Section F - Application or Permit to be Transferred to New Operator
10. Is this Change of Operator a full or partial transfer of all active permits? Full Partial
11. Application Number:
12. Permit Number: (Please attach a copy)
For RECLAIM Facilities, ALSO Complete This Section
(Also submit Form 2007-1, Form 2007-2 and if applicable, Form 2007-3, together with a separate filing fee for the
transfer of RTC’s as per Rule 301(l)(9):
Device number or range of device numbers for the permitted item:
Please be advised that you are applying to take over the operation of all or part of a RECLAIM facility and if any previous Facility Permit holder
is found to have violated AQMD Rule 2004(d) - Prohibition of Emissions in Excess of Annual Allocation, during time periods prior to this
change of operator, your facility Allocation will be reduced by the amount of excess emissions, as provided under Rule 2010(b)(1).
Section G - Signature and Authorization for Change of Operator
Previous
Operator
I HEREBY AGREE TO TRANSFER OWNERSHIP OF THE PERMITTED EQUIPMENT AS SPECIFIED ABOVE, FOR THIS FACILITY, TO
THE NEW LEGAL OPERATOR, IDENTIFIED IN SECTION B.
13. Signature of Responsible Official:
15. Ti
tle of Responsible Official:
14. Date:
16. Phone:
New
Operator
17. Signature of Responsible Official:
19. Ti
tle of Responsible Official:
18. Date:
20. Phone:
Checkli
st
Form signed?
Payment attached?
Copy of existing
permit attached?
New AQMD Facility ID
(TO BE COMPLETED BY AQMD)
