Transfer of Ownership/Name Change Application 2023

YOLO-SOLANO AIR QUALITY MANAGEMENT DISTRICT

PERMIT TO OPERATE (PTO) - TRANSFER OF OWNERSHIP/NAME CHANGE APPLICATION
A separate application is required for each facility location. This application form does not allow any changes to the permitted operations. Any changes in the process including equipment inventory, location, conditions and throughput of the existing PTO requires the owner to go through the Authority to Construct (ATC) process prior to making the change. In addition, if transferring ownership, if the permit(s) are subject to source testing, the frequency is based on the last time the equipment passed a source test, not the date of the permit transfer. Contact the District if you need assistance.
INSTRUCTIONS

YOU ARE ADVISED TO CALL THE DISTRICT OFFICE FOR ASSISTANCE AT
(530) 757-3650.

ENSURE YOUR APPLICATION IS COMPLETE:
- Submit correct fee (Master Fee Schedule)
- Outstanding and/or compliance issues could delay the transfer process
- Transfer of ownership requires the former owner to sign the application form or release responsiblity by letter.
- ANNUAL THROUGPUT FORM MUST ALSO BE SUBMITTED BY PRIOR OWNER UNDER A TRANSFER OF OWNERSHIP FOR THE PERIOD OF TIME THE OPERATION WAS UNDER THEIR CONTROL.
Type of Change

Tansfer of OwnershipName Change
NAME OF BUSINESS/ORGANIZATION THAT IS TO RECEIVE THE PERMIT(S)
DBA (if applicable)
EQUIPMENT LOCATION (where equipment is physically located)

Street Address

CityState / Province

Postal / Zip Code
Phone Number
Please enter a calid phone number.
Fax Number
Please enter a valid fax number.
Mailing Address (If different from equipment location address)

Street Address

Street Address

CityState / Province

Postal / Zip Code
Department or Title (If requested to appear on Permit)
Billing Address (if different than mailing address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Department Or Title (If You Want This To Be Listed On Invoices)
Billing Phone Number
Please enter a valid phone number.
Billing Email Address
example@example.com
SIGNATURE OF NEW RESPONSIBLE OFFICIAL (By signing this document you are indicating that all information contained in this document and in all attachments are true, accurate and complete to the best of your knowledge. Electronic signatures shall have the same legal effect as an original.)*

Clear
Printed Name
Title
Date

MonthDayYear
Date
Phone Number
Fax Number
Please enter a valid phone number.
Email Address
example@example.com
CONTACT PERSON FOR INFORMATION SUBMITTED WITH THIS APPLICATION, IF DIFFERENT THAN ABOVE:
Name
Title
Phone Number
Fax Number
Email Address
example@example.com
FOR TRANSFER OF OWNERSHIP ONLY:

RELEASE OF RESPONSIBILITY BY PREVIOUS OWNER/RESPONSIBLE OFFICIAL:
Name of Business/Organization Transferring Ownership
Contact Name
Phone Number
Signature

Clear
Date

MonthDayYear
Date
Effective Date of Transfer of Ownership

MonthDayYear
Date
If you are unable to receive a signature or letter releasing responsibility by previous owner, explain below
Should be Empty:

YOLO-SOLANO AIR QUALITY MANAGEMENT DISTRICT

FOR TRANSFER OF OWNERSHIP ONLY: