Name:

Company:

Title:

State, Zip

City:

Phone:

Address:

Email:

Fax:

A. New Equipment Owner

Name:

Company:

Title:

State, Zip

City:

Phone:

Address:

Email:

Fax:

B. New Equipment Operator

Transfer of Owner/Operator of Permitted Equipment

Application Form -01T Santa Barbara County Air Pollution Control District

260 N. San Antonio Road, Suite A Santa Barbara, CA 93110-1315

APCD - 01T (07/2019) For APCD use only. FID # App. #

Current APCD Permit Number:This form is to be completed by the new owner/operator

Prior Owner/Operator:

Facility Address/Location:(e.g. Fairview Ave., 55 N)

Old Company Name:

Name:

Company:

Title:

State, Zip

City:

Phone:

Address:

Email:

Fax:

Name:

Company:

Title:

State, Zip

City:

Phone:

Address:

Email:

Fax:

C. Correspondence Contact D. Billing Contact

Same as A Same as B Same as B Same as A Same as C

Transfer of Owner/Operator of Permitted Equipment Application Form - 01T

Page 2 of 2

Is the article, machine, equipment, or contrivance subject to the permit in compliance with all applicable orders, rules and regulations of the APCD, Air Resources Board and the Environmental Protection Agency?

Yes No

Is a written agreement or other written proof of transfer of ownership, which specifies the date of ownership transfer enclosed? (not required for changes in operator only). Note: The transfer will not be processed without this documentation.

Yes No

Please complete the following:

Have all fees associated with the permit been paid? (i.e Annual Emissions/AB2588, Reevalutation)

Yes No

On what date did the change of ownership or operator officially occur?

a.

b.

Yes No

c.

d.

Is the application filing fee of $420 enclosed?* (application will not be accepted without a filing fee)e.

Completed by: Title:

Date: Phone:

Signature:

Please note that the application filing fee is COLA adjusted every July 1st. Please ensure you are remitting the current fee. Payment may be made by credit card (see Form -01C on the APCD's webpage at www.ourair.org/permit-applications)

*

APCD -01T (07/2019)