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) 979-8050 or email [email protected]


  • 12/26/2023: Form-15, the Health Risk Assessment application form, was updated: apcd-15.pdf.
  • 07/10/2023: The Cannabis Processing, Manufacturing, Distribution & Storage application form apcd-104.pdf was updated.
  • 07/01/2023: See updated District Fees.
  • 03/29/2022: Form-25T, the gas station HRA application form, was updated: apcd-25T.pdf.
  • 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 NameAdobe PDF
Title 5Title 5 Operating Permit Forms (includes all application and reporting forms)t5-forms.pdf
AG-1Agricultural Engine Registration Application Formag1.pdf
AG-2Instructions For Use of Agricultural Engine Registration Form AG-1ag2.pdf
AG-3Ag Engine Change Notification Formag3.pdf
 APCD-01Permit Application – Generalapcd-01.pdf
 APCD-01aAuthorized Agent Formapcd-01a.pdf
APCD-01CCredit Card Formapcd-01c.pdf
APCD-01TTransfer of Owner/Operatorapcd-01T.pdf
APCD-02BACT Analysis Summary Formapcd-02.pdf
APCD-02a/bRule 331 BACT Replacement Guidelines and Forms331bact.pdf
APCD-03School Summary Formapcd-03.pdf
APCD-05AEmission Reduction Credits – Creating New ERCsapcd-05a.pdf
APCD-05EEmission Reduction Credits – Creating New ERCs for Agricultural Facilitiesapcd-05e.pdf
APCD-05EREmission Reduction Credits – Returning Creditsapcd-05er.pdf
APCD-05REmission Reduction Credits – Renewalapcd-05r.pdf
APCD-05TEmission Reduction Credits – Transferapcd-05t.pdf
APCD-05UEmission Reduction Credits – Authorization of ERC Useapcd-05u.pdf
APCD-05VTEmission Reduction Credits – VAFB Returnapcd-05vt.pdf
APCD-06Application Requirements for Contaminated Soil Cleanupapcd-06.pdf
APCD-07Guidance Document For Emission Verification Of Contaminated Soil/Groundwater Cleanup (CSC) Processesapcd-07.pdf
APCD-07ARequest For Exemption From Permit Requirement For Contaminated Soil Excavation of 1,000 yd3 or Lessapcd-07a.pdf
APCD-07BRequest For Exemption From Permit Requirement For Pilot Tests For Soil Remediation Sitesapcd-07b.pdf
APCD-07CContaminated Soil Excavation Projects (over 1,000 yd3)apcd-07c.pdf
APCD-08Fiberglassing Operation/Resin Usageapcd-08.pdf
APCD-08AFiberglassing Facility Applicationsapcd-08a.pdf
APCD-09Exhaust Hood Summaryapcd-09.pdf
APCD-10IC Engine Timing Certification Formapcd-10.pdf
APCD-13Bake Oven Summaryapcd-13.pdf
APCD-14Rule 360 Compliance Reportapcd-14.pdf
APCD-14ARule 360 Summary of Requirementsapcd-14A.pdf
APCD-15Health Risk Assessment Applicationapcd-15.pdf
APCD-15cAir Toxics Certificationapcd-15c.pdf
APCD-15iHealth Risk Assessment Application Instructionsapcd-15i.pdf
APCD-17Solvent Recovery Plan Guideline Document and Application Formapcd-17.pdf
APCD-18Solvent Usage/Wipe Cleaningapcd-18.pdf
APCD-19Sand, Rock and Gravel Facilitiesapcd-19.pdf
APCD-22Surface Coatingapcd-22.pdf
 APCD-25Gas Station Application Formapcd-25.pdf
APCD-25EGas Station EVR Supplemental Formapcd-25e.pdf
APCD-25AGas Station AST Supplemental Formapcd-25a.pdf
APCD-25PGas Station PTO Application Formapcd-25p.pdf
APCD-25bBulk Fuel Storage Facility Summaryapcd-25b.pdf
APCD-25TGas Station HRA Application Formapcd-25T.pdf
APCD-26Emergency Episode Plan for Stationary Source Curtailmentapcd-26.pdf
APCD-27Emergency Episode Plan for Traffic Abatementapcd-27.pdf
APCD-29Parameters & Emission Summaryapcd-29.pdf
APCD-33External Combustion Equipment – Boilersapcd-33.pdf
APCD-34ADiesel-Fired Primary Agricultural Engineapcd-34a.pdf
 APCD-34EDiesel-Fired Emergency/Standby Engineapcd-34e.pdf
APCD-34PDiesel-Fired Primary Engine apcd-34p.pdf
APCD-34RDiesel-Engine ATCM Inventory Formapcd-34r.pdf
APCD-35In-Use 20 Hour or Less Diesel-Fired Emergency/Standby Engineapcd-35.pdf
APCD-36New Residential Diesel-Fired Emergency/Standby Engineapcd-36.pdf
APCD-37Existing  Residential Diesel-Fired Emergency/Standby Engineapcd-37.pdf
APCD-38Request for Written Determination of Permit Exemptionapcd-38.pdf
APCD-38BRequest for Written Determination of Permit Exemption – Breweriesapcd-38b.pdf
APCD-38DRequest for Written Determination of Permit Exemption – Distilled Spiritsapcd-38d.pdf
APCD-38MMarine Vessel Exemption Request Formapcd-38m.pdf
APCD-38P14 Day PERP Notification – State Territorial Waters and Outer Continental Shelfapcd-38p.pdf
APCD-38WRequest for Written Determination of Permit Exemption – Wineriesapcd-38w.pdf
APCD-39Vapor Recovery Systems Defect Guideapcd-39.pdf
APCD-43Dry Cleaning Equipmentapcd-43.pdf
APCD-44Degreaser Summary Formapcd-44.pdf
APCD-45Odorant & Metering Stationapcd-45.pdf
APCD-46Concrete Batch Plant Formapcd-46.pdf
APCD-47Fabric Filter Formapcd-47.pdf
APCD-50Winery Fermentation and Storage/Aging Tanks Formapcd-50.pdf
APCD-60Small Boilers and Process Heaters – Installed Prior to January 17, 2008apcd-60.pdf
APCD-61Small Boilers and Process Heaters – Installed After January 16, 2008apcd-61.pdf
APCD-70Spark-Ignited Reciprocating Internal Combustion Engine Formapcd-70.pdf
APCD-77Contaminated Soil and/or Groundwater Clean-Upapcd-77.pdf
APCD-95Chrome Plating or Chromic Acid Anodizingapcd-95.pdf
APCD-102Autobody Shop and Mobile Equipment Coating Operating Supplemental Formapcd-102.pdf
APCD-103Monthly Motor Vehicle Refinishing, Coating, Surface Prep and Cleanup Solvent Logapcd-103.pdf
APCD-104Cannabis Product Manufacturing, Distribution & Storage Formapcd-104.pdf
APCD 200-00Oil and Gas General Formapcd-200-00.pdf
APCD 200-01Compressorsapcd-200-01.pdf
APCD 200-02ES DICEapcd-200-02.pdf
APCD 200-03Prime Dieselapcd-200-03.pdf
APCD 200-04Spark Ignited Engineapcd-200-04.pdf
APCD 200-05External Combustionapcd-200-05.pdf
APCD 200-06Fixed Roof Tanksapcd-200-06.pdf
APCD 200-07Floating Roof Tanksapcd-200-07.pdf
APCD 200-08Waste Water Tanksapcd-200-08.pdf
APCD 200-09Wellsapcd-200-09.pdf
APCD 200-10Sump Pit and Well Cellarapcd-200-10.pdf
APCD 200-11Separatorsapcd-200-11.pdf
APCD 200-12Loading Rackapcd-200-12.pdf
APCD 200-13Pigging Equipmentapcd-200-13.pdf
APCD 200-14Flares or Thermal Oxidizerapcd-200-14.pdf
APCD 200-15H2S Scrubberapcd-200-15.pdf
APCD 200-16Miscellaneous Equipmentapcd-200-16.pdf
APCD 200-17Pneumatic Controllerapcd-200-17.pdf
APCD 200-18Fuel Metersapcd-200-18.pdf
APCD 200-19Engine Diesel Particulate Filterapcd-200-19.pdf
APCD 200-20Fugitivesapcd-200-20.pdf
APCD 200-21Critical Component Design and Review Checklistapcd-200-21.pdf