North Central Coast: Lake Tahoe: South Central Coast: San Joaquin Valley: South Coast: Basin Valleys: San Diego County: Mojave Desert: Outside California: Salton Sea: Note: The total of all percentages must equal 100. I certify under penalty of perjury that the Information provided above is accurate and true. Signature: _______________________ Name: __________________________ Date: ___________________________
O-1B: Light And Medium Heavy-Duty (GVWR = 14,001 to 26,000 lbs) Fleets of 1-10 trucks Replacement vehicle with 2013 or newer engine delivered/post-inspected by Dec. 31, 2017 No Truck and Bus Regulatory 2010 std. compliance date before January 1, 2021 Must show current TRUCRS documentation (compliance certificate and reported compliance option) (ENGINE YEAR SCHEDULE NOT ELIGIBLE) NEW REPLACEMENT Engine Model Year 0.20 g/bhp-hr NOx Standard or Cleaner Minimum Annual Usage Funding Amount Miles Gallons < 1990 10,000 1,000 $10,000 13,000 1,300 $15,000 16,000 1,600 $20,000 19,000 1,900 $25,000 22,000 2,200 $30,000 1991-1998 13,000 1,300 $10,000 17,000 1,700 $15,000 21,000 2,100 $20,000 25,000 2,500 $25,000 28,000 2,800 $30,000 USED REPLACEMENT Engine Model Year 0.20 g/bhp-hr NOx Standard or Cleaner Minimum Annual Usage Funding Amount Miles Gallons < 1990 10,000 1,000 $10,000 14,000 1,400 $15,000 17,000 1,700 $20,000 1991-1998 14,000 1,400 $10,000 18,000 1,800 $15,000 23,000 2,300 $20,000
Table O-2B: Medium Heavy-Duty (GVWR = 19,501 to 26,000 lbs) Fleets of 1-10 trucks Replacement vehicle with 2013 or newer engine delivered/post-inspected by Dec. 31, 2017 Must show current TRUCRS documentation (compliance certificate and reported compliance option) (ENGINE MODEL YEAR SCHEDULE ONLY) USED REPLACEMENT 0.20 g/bhp-hr NOx Standard or Cleaner Engine Model Year Minimum Annual Usage Funding Amount Gallons 1999 No and Bus Regulatory compliance due before January 1, 2019 18,000 1,800 $10,000 24,000 2,400 $15,000 28,000 2,800 $20,000 32,000 3,200 $25,000 36,000 3,600 $30,000 2000-2002 No Truck and Bus Regulatory compliance due before January 1, 2020 12,000 1,200 $10,000 16,000 1,600 $15,000 19,000 1,900 $20,000 22,000 2,200 $25,000 25,000 2,500 $30,000 2003 No and Bus Regulatory compliance due before January 1, 2020 16,000 1,600 $10,000 22,000 2,200 $15,000 26,000 2,600 $20,000 30,000 3,000 $25,000 34,000 3,400 $30,000 2004-2006 No Truck and Bus Regulatory compliance due before January 1, 2021 13,000 1,300 $10,000 18,000 1,800 $15,000 21,000 2,100 $20,000 25,000 2,500 $25,000 28,000 2,800 $30,000 2007-2009 No and Bus Regulatory compliance due before January 1, 2021 30,000 3,000 $10,000 38,000 3,700 $15,000 45,000 4,400 $20,000 51,000 5,000 $25,000 57,000 5,600 $30,000
Address: City, State, Zip: Federal Tax ID Number: Please reimburse <Dealer Name> for <$0.00> for the voucher number _______. A complete reimbursement package will be turned in at the time of payment. Thank you. Name: ______________________________ Signature: ___________________________ Date: ______________________ Appendix I OFF-ROAD VOUCHER INCENTIVE PROGRAM Inspection Form Type of Inspection: Existing Equipment: Pre-Inspection Pre-Dismantle Dismantle Post-Inspection: Replacement Equipment Post-Inspection Legible Pictures: Yes No Applicant Information Company Name: Inspection Location: Owner Name: Address: City, Zip: Phone Number: Equipment and Engine Information Existing equipment Replacement Equipment Equipment Information: Equipment Make: Equipment Equipment Model Year: EIN (if applicable): Equipment Serial Number: Date of Manufacture: Fleet ID: Hour Reading: Equipment operational? Yes No
Engine Information: Engine Make: Engine Model: Engine Year: Date of Manufacture: Engine Serial Number or Air District ID Number: Engine Horsepower: Engine operational? Yes No Fuel used? Diesel Other: Engine Family Number: For Pre-Dismantler Inspection ONLY, Specify Dismantler: Contact Name: Phone: Engine operational? Yes No For Dismantler Inspection ONLY, Specify Dismantler: Contact Name: Frame Rails Cut? Yes No Engine Destroyed? Yes No Comments: I certify under penalty of perjury that: 1) the information provided above is accurate, 2) the pictures are of the inspected equipment, 3) the pictures clearly depict the inspected equipment, and 4) that I understand that this inspection form is incorporated in the agreement with the <air district>. Signature: Date: Authorized Name: Air District / Dealership: Address: City, State, Zip: Phone Number: