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P101b FRM P101B

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BAY AREA AIR QUALITY MANAGEMENT DISTRICT
Form P-101B
375 Beale Street, Suite 600, San Francisco, CA 94105
Authority to Construct/
Engineering Division
(415) 749-4990
Permit to Operate
www.baaqmd.gov
fax
(415) 749-5030
- 1 -
1. Application Information
Company Name
Equipment/Project Description
2. Plant Information If you have not previously been assigned a Plant Number by the District or if you want to update any plant
data that you have previously supplied to the District, please complete this section.
Zip Code
State
Zip Code
Title
( )
Fax
( )
Email
NAICS (North American Industry Classification System) see www.census.gov/eos/www/naics/
3. Proximity to a School (K-12)
The sources in this permit application (check one) Are Are not within 1,000 ft of the outer boundary of the nearest school.
4. Application Contact Information All correspondence from the District regarding this application will be sent to the plant
contact unless you wish to designate a different contact for this application.
Application Contact
Title
Mail Address
City
State
Zip Code
Telephone
( )
Fax
( )
Email
5. Additional Information The following additional information is required for all permit applications and should be included with
your submittal. Failure to provide this information may delay the review of your application. Please indicate that each item has
been addressed by checking the box. Contact the Engineering Division if you need assistance.
If a new Plant, a local street map showing the location of your business
A facility map, drawn roughly to scale, that locates the equipment and its emission points
Completed data form(s) and a pollutant flow diagram for each piece of equipment.
(See www.baaqmd.gov/forms/permits )
Project/equipment description, manufacturer’s data
Discussion and/or calculations of the emissions of air pollutants from the equipment
6. Trade Secrets Under the California Public Records Act, all information in your permit application will be considered a matter of
public record and may be disclosed to a third party. If you wish to keep certain items separate as specified in Regulation 2, Rule 1,
Section 2-1-402.7, please complete the following steps.
Each page containing trade secret information must be labeled “trade secret” with the trade secret information clearly marked.
A second copy, with trade secret information blanked out, marked “public copy” must be provided.
For each item asserted to be trade secret, you must provide a statement which provides the basis for your claim.
- 2
(revised 4/12/16)
7. Small Business Certification You are entitled to a reduced permit fee if you qualify as a small business as defined in
Regulation 3. In order to qualify, you must certify that your business meets all of the following criteria:
The business does not employ more than 10 persons and its gross annual income does not exceed $750,000.
And the business is not an affiliate of a non-small business. (Note: a non-small business employs more than 10 persons and/or
its gross income exceeds $750,000.)
8. Green Business Certification You are entitled to a reduced permit fee if you qualify as a green business as defined in
Regulation 3. In order to qualify, you must certify that your business meets all of the following criteria:
The business has been certified under the Bay Area Green Business Program coordinated by the Association of Bay Area
Governments and implemented by participating counties.
A copy of the certification is included.
9. Accelerated Permitting The Accelerated Permitting Program entitles you to install and operate qualifying sources of air
pollution and abatement equipment without waiting for the District to issue a Permit to Operate. To participate in this program
you must certify that your project will meet all of the following criteria. Please acknowledge each item by checking each box.
Uncontrolled emissions of any single pollutant are each less than 10 lb/highest day, or the equipment has been precertified by the
BAAQMD.
Emissions of toxic compounds do not exceed the trigger levels identified in Table 2-5-1 (see Regulation 2, Rule 5).
The source is not a diesel engine.
The project is not subject to public notice requirements (the source is either more than 1000 ft. from the nearest school, or the
source does not emit any toxic compound in Table 2-5-1).
For replacement of abatement equipment, the new equipment must have an equal or greater overall abatement efficiency for all
pollutants than the equipment being replaced.
For alterations of existing sources, for all pollutants the alteration does not result in an increase in emissions.
Payment of applicable fees (the minimum permit fee to install and operate each source). See Regulation 3 or contact the
Engineering Division for help in determining your fees.
10. CEQA Please answer the following questions pertaining to CEQA (California Environmental Quality Act).
A. Has another public agency prepared, required preparation of, or issued a notice regarding preparation of a California Environmental
Quality Act (CEQA) document (initial study, negative declaration, environmental impact report, or other CEQA document) that
analyzes impacts of this project or another project of which it is a part or to which it is related? YES NO If no, go to section 10B.
Describe the document or notice, preparer, and date of document or expected date of completion:
B. List and describe any other permits or agency approvals required for this project by city, regional, state or federal agencies:
C. List and describe all other prior or current projects for which either of the following statements is true: (1) the project that is the
subject of this application could not be undertaken without the project listed below, (2) the project listed below could not be
undertaken without the project that is the subject of this application:
11. Certification I hereby certify that all information contained herein is true and correct. (Please sign and date this form)
Name of person certifying (print) Title of person certifying Signature of person certifying
Date
Send all application materials to the BAAQMD Engineering Division, 375 Beale Street, Suite 600, San Francisco, CA 94105.
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P101b FRM P101B

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Completed 18 April 2020

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