Fill - Free fillable Transfer Of Ownership Form (Bay Area Air Quality Management District) PDF form

BAY AREA AIR QUALITY MANAGEMENT DISTRICT

TRANSFER OF OWNERSHIP FORM

Transfer of currently permitted devices from one facility to another facility

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

(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 transferring to a new facility (not currently permitted by BAAQMD) a Facility Creation Form and a Facility

Contacts Form must also be submitted with this form.

1. Reason for submitting this form

Select one:

I am the current owner/operator of the permit(s) and will be transferring permits to another facility.

I am not the current owner/operator of the permit(s) and I will identify permits to be transferred to another facility.

2. Identification of Facility Currently Holding Permits to be Transferred to Facility Identified in Part 3

Facility Name

BAAQMD Facility ID

3. Identification of Facility to Receive Transferred Permits Currently Being Held by the Facility Identified in Part 2

Facility Name

BAAQMD Facility ID (Existing facilities only)

 If new facility, complete address information below. Information must match Facility Creation Form.

Street Address or Intersection or Nearest Street

Address Line 2 (Optional)

City

State

Zip Code

4. Transferring Device Identification

Identify the type of transfer: (Select one)

This is a full transfer of all devices This is a partial transfer

If this is a partial transfer, enter all devices requesting to be transferred. All devices start with S, A or P.

BAAQMD Device ID

5. Effective Date

Provide the effective date of the transfer (MM/DD/YYYY)

6. Payment – Submit payment with your forms.

 Transfer of Ownership fee $102 From BAAQMD Regulation 3, Section 307

Pay by credit card or check. Please make your checks payable to "BAAQMD". For credit card payments, fill out and submit a

“Credit Card Payment Form” which is available on the BAAQMD website.

7. 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:TransferofOwnershipForm

Introduction UsethefollowinginstructionstohelpguideyouthroughtheTransferofOwnership

form.

Whoshoulduse

thisform?

Thisformistransferdevices/operationsthatarecurrentlypermittedbyBAAQMDfrom

onefacilitytoanother.ThepermitscanbethePermittoOperateandanyAuthorityto

Constructpermits.Thetransfercanbeappliedtoalldevices/operationsorapartialset

ofdevices/operations.

Reasonfor

submittingthis

form



IfyouarenotthecurrentholderoftheBAAQMDpermit,BAAQMDwillattemptto

contactthecurrentholderofthepermitforverification.

Identificationof

Facility

Currently

HoldingPermits

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.

Identificationof

Facilityto

Receive

Transferred

Permits



Thepermitsareeithertransferredtoanotherfacilitythatiscurrentlypermittedby

BAAQMDoranewfacility.Fortheformer,theBAAQMDfacilityIDisavailableonthe

permitorinvoiceissuedbyBAAQMD.Foranewfacility,enterthenewinformation

ANDsubmitaFacilityCreationFormANDaFacilityContactsForm.

Transferring

Device

Identification

Forafulltransfer,youarerequestingthatalldevicesbetransferred.

Forapartialtransfer,enterthedevicesthatyouarerequestingbetransferred.Referto

thecurrentBAAQMDpermit.AlldevicesstartwithanS,AorP.Ifyouneedmorespace,

attachanotherformoraseparatesheetofpaperwiththesameinformation.

EffectiveDate Enteradatewhenthistransferistobeeffective.Onthatdate,thenewowner/operator

isresponsibleforthepermitsandoperationofthedevicesidentifiedontheform.

Fees

PaymentoftheTransferfeemustbesubmittedwiththisform.Thefeeis$102.The

feeislocatedinBAAQMDRegulation3,Section307.

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

Fill Online, Printable, Fillable, Blank Transfer Of Ownership Form (Bay Area Air Quality Management District) Form

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Fillable Transfer Of Ownership Form (Bay Area Air Quality Management District)

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