## San Joaquin Valley Air Pollution Control District

www.valleyair.org



### CONSERVATION MANAGEMENT PRACTICE PLAN (CMPP)

APPLICATION FOR

[ ] TRANSFER OF OWNERSHIP [ ] NAME CHANGE ONLY No change in facility ownership has occurred.

1. CMP PLAN(S) TO BE ISSUED TO:

2. MAILING ADDRESS:

STREET/P.O. BOX: _____________________________

___________________________________________________ ___________________________________________________ ______ 9-DIGIT

CITY: STATE: ZIP CODE: ________________________

3. LOCATION OF THE FACILITY THE CMP PLAN IS COVERI NG:

STREET: _______________________________________

___________________________________________________ ___________________________________________________ ________

CITY: _________________________________________

___________________________________________________ ___________________________________________________ ________

4. CMP PLAN ID NO(S).:

5. SIGNATURE OF APPLICANT (Acquiring Owner or Representative) : TYPE OR PRINT TITLE OF APPLICANT:

6. TYPE OR PRINT NAME OF APPLICANT: DATE: TELEPHONE NO:

7. CMP PLAN(S) CURRENTLY ISSUED TO:

8. MAILING ADDRESS:

STREET/P.O. BOX: ____________________________

___________________________________________________ ___________________________________________________ _______ 9-DIGIT

CITY: STATE: ZIP CODE:

FOR APCD USE ONLY:

DATE STAMP

FILING FEE RECEIVED: $ /

DATE PAID:

PROJECT NO.: FACILITY ID.: ________________________	

 	 

  	  
 
  

 
     	   

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## TRANSFER OF OWNERSHIP

LETTER OF RELEASE

, as current holder

(PRINT BUSINESS NAME AS CURRENTLY LISTED ON CMP Plan) 

### of record of Conservation Management Practices Plan (as listed below)

issued by the San Joaquin Valley Unified Air Pollut ion Control District

(SJVUAPCD), hereby releases all rights of ownership of the listed CMP
Plan

to _______________________________ as of __________

____________ (PRINT NAME OF BUSINESS TRANSFERRING TO) (EF FECTIVE DATE OF TRANSFER)



### CMP PLAN ID NUMBER(s)

(PLEASE LIST)



### ___________________________________________________ ________

___________________________________________________ ________

___________________________________________________ ________

___________________________________________________ ________ (USE ADDITIONAL SHEETS IF NECESSARY)



### SIGNED: DATE:

(PREVIOUS OR RELEASING OWNER’S SIGNATURE)



### NAME: TITLE:

(PRINT NAME)



### ACQUIRING COMPANY CONTACT (PLEASE PRINT)



### NAME: TELEPHONE: ( )

ADDRESS: