AGRICULTURAL ENGINE CANCELLATION FORM

YOLO-SOLANO AIR QUALITY MANAGEMENT DISTRICT

Agricultural Engine Registration Cancellation Request
Please complete this form to request an agricultural engine registration cancellation. All fields must be completed in order for the cancellation request to be accepted.
ACCOUNT INFORMATION
Account Name
Contact Name
Phone #
Email Address
example@example.com
EQUIPMENT INFORMATION
Ag Engine Sticker #*
Date Removed from Service*

MonthDayYear
Date
Final Hour Meter Reading
REASON FOR CANCELLATION
Type a question

ScrappedSoldRemains Onsite - Will never be used again (ex: in the scrap pile, kept for parts)
Scrapped To
Location
Sold To:
Name of Purchaser
Phone #
Address/Location
Signature

Clear
OPERATION OF AN ENGINE WITHOUT A VALID DISTRICT REGISTRATION IS PROHIBITED.
Please verify that you are human*
Should be Empty:

YOLO-SOLANO AIR QUALITY MANAGEMENT DISTRICT