Permit Application Forms

In response to the COVID-19 pandemic, the District is now accepting permit applications by e-mail. Completed and signed permit application forms can be scanned and e-mailed to [email protected]. If files are too large to submit via email, please contact us and District staff will arrange for an alternative solution.

In general, permit applications must contain form APCD-01 plus the appropriate equipment-specific form. Refer to the checklist at the end of each application form to see what supplemental information must be submitted with your permit application.

For more information about permitting specific types of requirements, see Engineering Programs or call (805) 979-8051 or email eng[email protected]


  • 03/29/2022: Form-25T, the gas station HRA application form, was updated: apcd-25T.pdf.
  • 07/01/2021: See updated District Fees.
  • 12/31/2020: The Air Toxics Certification form apcd-15c.pdf was newly published. This form must be submitted with all HRAs, ATEIPs, ATEIRs, and RRAPs.
  • 10/17/2019: The Cannabis Product Manufacturing, Distribution & Storage application form apcd-104.pdf was updated.
  • 08/14/2019: New Cannabis Product Manufacturing, Distribution & Storage application form is available: apcd-104.pdf
  • 07/26/2019: The Guidance Document For Emission Verification Of Contaminated Soil/Groundwater Cleanup (CSC) Processes was updated: apcd-07.pdf.
  • 10/11/2018: The following forms were updated: apcd-77.pdfapcd-07a, apcd-07b.pdf, apcd-07C.pdf
  • 05/29/2018: The Winery permit application form was updated: apcd-50.pdf
Form No. Form Name Adobe PDF
Title 5 Title 5 Operating Permit Forms (includes all application and reporting forms) t5-forms.pdf
AG-1 Agricultural Engine Registration Application Form ag1.pdf
AG-2 Instructions For Use of Agricultural Engine Registration Form AG-1 ag2.pdf
AG-3 Ag Engine Change Notification Form ag3.pdf
 APCD-01 Permit Application – General apcd-01.pdf
 APCD-01a Authorized Agent Form apcd-01a.pdf
APCD-01C Credit Card Form apcd-01c.pdf
APCD-01T Transfer of Owner/Operator apcd-01T.pdf
APCD-02 BACT Analysis Summary Form apcd-02.pdf
APCD-02a Rule 331 Candidate BACT Replacement Form 331bact.pdf
APCD-02b Rule 331 Alternate BACT Replacement Proposal Form 331bact.pdf
APCD-03 School Summary Form apcd-03.pdf
APCD-05A Emission Reduction Credits – Creating New ERCs apcd-05a.pdf
APCD-05E Emission Reduction Credits – Creating New ERCs for Agricultural Facilities apcd-05e.pdf
APCD-05ER Emission Reduction Credits – Returning Credits apcd-05er.pdf
APCD-05R Emission Reduction Credits – Renewal apcd-05r.pdf
APCD-05T Emission Reduction Credits – Transfer apcd-05t.pdf
APCD-05U Emission Reduction Credits – Authorization of ERC Use apcd-05u.pdf
APCD-05VT Emission Reduction Credits – VAFB Return apcd-05vt.pdf
APCD-06 Application Requirements for Contaminated Soil Cleanup apcd-06.pdf
APCD-07 Guidance Document For Emission Verification Of Contaminated Soil/Groundwater Cleanup (CSC) Processes apcd-07.pdf
APCD-07A Request For Exemption From Permit Requirement For Contaminated Soil Excavation of 1,000 yd3 or Less apcd-07a.pdf
APCD-07B Request For Exemption From Permit Requirement For Pilot Tests For Soil Remediation Sites apcd-07b.pdf
APCD-07C Contaminated Soil Excavation Projects (over 1,000 yd3) apcd-07c.pdf
APCD-08 Fiberglassing Operation/Resin Usage apcd-08.pdf
APCD-08A Fiberglassing Facility Applications apcd-08a.pdf
APCD-09 Exhaust Hood Summary apcd-09.pdf
APCD-10 IC Engine Timing Certification Form apcd-10.pdf
APCD-13 Bake Oven Summary apcd-13.pdf
APCD-14 Rule 360 Compliance Report apcd-14.pdf
APCD-14A Rule 360 Summary of Requirements apcd-14A.pdf
APCD-15 Health Risk Assessment Application apcd-15.pdf
APCD-15c Air Toxics Certification apcd-15c.pdf
APCD-15i Health Risk Assessment Application Instructions apcd-15i.pdf
APCD-17 Solvent Recovery Plan Guideline Document and Application Form apcd-17.pdf
APCD-18 Solvent Usage/Wipe Cleaning apcd-18.pdf
APCD-19 Sand, Rock and Gravel Facilities apcd-19.pdf
APCD-22 Surface Coating apcd-22.pdf
 APCD-25 Gas Station Application Form apcd-25.pdf
APCD-25E Gas Station EVR Supplemental Form apcd-25e.pdf
APCD-25A Gas Station AST Supplemental Form apcd-25a.pdf
APCD-25P Gas Station PTO Application Form apcd-25p.pdf
APCD-25b Bulk Fuel Storage Facility Summary apcd-25b.pdf
APCD-25T Gas Station HRA Application Form apcd-25T.pdf
APCD-26 Emergency Episode Plan for Stationary Source Curtailment apcd-26.pdf
APCD-27 Emergency Episode Plan for Traffic Abatement apcd-27.pdf
APCD-29 Parameters & Emission Summary apcd-29.pdf
APCD-33 External Combustion Equipment – Boilers apcd-33.pdf
APCD-34A Diesel-Fired Primary Agricultural Engine apcd-34a.pdf
 APCD-34E Diesel-Fired Emergency/Standby Engine apcd-34e.pdf
APCD-34P Diesel-Fired Primary Engine apcd-34p.pdf
APCD-34R Diesel-Engine ATCM Inventory Form apcd-34r.pdf
APCD-35 In-Use 20 Hour or Less Diesel-Fired Emergency/Standby Engine apcd-35.pdf
APCD-36 New Residential Diesel-Fired Emergency/Standby Engine apcd-36.pdf
APCD-37 Existing  Residential Diesel-Fired Emergency/Standby Engine apcd-37.pdf
APCD-38 Request for Written Determination of Permit Exemption apcd-38.pdf
APCD-38B Request for Written Determination of Permit Exemption – Breweries apcd-38b.pdf
APCD-38D Request for Written Determination of Permit Exemption – Distilled Spirits apcd-38d.pdf
APCD-38M Marine Vessel Exemption Request Form apcd-38m.pdf
APCD-38P 14 Day PERP Notification – State Territorial Waters and Outer Continental Shelf apcd-38p.pdf
APCD-38W Request for Written Determination of Permit Exemption – Wineries apcd-38w.pdf
APCD-39 Vapor Recovery Systems Defect Guide apcd-39.pdf
APCD-43 Dry Cleaning Equipment apcd-43.pdf
APCD-44 Degreaser Summary Form apcd-44.pdf
APCD-45 Odorant & Metering Station apcd-45.pdf
APCD-46 Concrete Batch Plant Form apcd-46.pdf
APCD-47 Fabric Filter Form apcd-47.pdf
APCD-50 Winery Fermentation and Storage/Aging Tanks Form apcd-50.pdf
APCD-60 Small Boilers and Process Heaters – Installed Prior to January 17, 2008 apcd-60.pdf
APCD-61 Small Boilers and Process Heaters – Installed After January 16, 2008 apcd-61.pdf
APCD-70 Spark-Ignited Reciprocating Internal Combustion Engine Form apcd-70.pdf
APCD-77 Contaminated Soil and/or Groundwater Clean-Up apcd-77.pdf
APCD-95 Chrome Plating or Chromic Acid Anodizing apcd-95.pdf
APCD-102 Autobody Shop and Mobile Equipment Coating Operating Supplemental Form apcd-102.pdf
APCD-103 Monthly Motor Vehicle Refinishing, Coating, Surface Prep and Cleanup Solvent Log apcd-103.pdf
APCD-104 Cannabis Product Manufacturing, Distribution & Storage Form apcd-104.pdf
APCD 200-00 Oil and Gas General Form apcd-200-00.pdf
APCD 200-01 Compressors apcd-200-01.pdf
APCD 200-02 ES DICE apcd-200-02.pdf
APCD 200-03 Prime Diesel apcd-200-03.pdf
APCD 200-04 Spark Ignited Engine apcd-200-04.pdf
APCD 200-05 External Combustion apcd-200-05.pdf
APCD 200-06 Fixed Roof Tanks apcd-200-06.pdf
APCD 200-07 Floating Roof Tanks apcd-200-07.pdf
APCD 200-08 Waste Water Tanks apcd-200-08.pdf
APCD 200-09 Wells apcd-200-09.pdf
APCD 200-10 Sump Pit and Well Cellar apcd-200-10.pdf
APCD 200-11 Separators apcd-200-11.pdf
APCD 200-12 Loading Rack apcd-200-12.pdf
APCD 200-13 Pigging Equipment apcd-200-13.pdf
APCD 200-14 Flares or Thermal Oxidizer apcd-200-14.pdf
APCD 200-15 H2S Scrubber apcd-200-15.pdf
APCD 200-16 Miscellaneous Equipment apcd-200-16.pdf
APCD 200-17 Pneumatic Controller apcd-200-17.pdf
APCD 200-18 Fuel Meters apcd-200-18.pdf
APCD 200-19 Engine Diesel Particulate Filter apcd-200-19.pdf
APCD 200-20 Fugitives apcd-200-20.pdf
APCD 200-21 Critical Component Design and Review Checklist apcd-200-21.pdf
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New Phone Numbers
The District has new direct lines for all staff, as well as for all of our phone lines, including our main phone number and Complaints line. You can find our new phone numbers on this webpage.

Nuevos números de teléfono
El Distrito tiene nuevos números de teléfono para comunicarse con el personal directamente, así como también para todas nuestras líneas telefónicas, incluyendo nuestro número principal y el de las Quejas. Puede encontrar nuestros nuevos números de teléfono en esta página web.