application for authority to construct and permit to operate

3433 Roberto Court, San Luis Obispo, CA 93401Phone: (805) 781-5912 FAX: (805) 781-1002Email: info@slocleanair.orgWeb Site: www.slocleanair.orgWINE OPERATIONS PERMIT APPLICATION FORMIMPORTANT: Application must be typewritten, computer generated, or neatly hand printed in black or blue ink.Complete all pages of application. Applications are evaluated on a cost recovery basis - the filing fee will be applied as acredit to the final amount due. To assure that your application is complete include all of the following with submittal:$195 Filing Fee Completed Supplemental Forms Signature on Application1. Type of Application:Permit - Existing EquipmentPermit - New EquipmentModify Permit2. Facility Name:Facility Street AddressExisting Permit # (if applicable:)Modify Authority to ConstructModify Permit ConditionAssessor Parcel Number (APN)if known:City, State ZIP:3. Owner:Contact Person:Company Name:Mailing Address:City, State ZIP:Work:FAX:Cell:Email:4. Other Contacts: (If contact is not the same as owner please attach the APCD Permit Contacts form with the information)Facility Operations:Same same as as Owner owner Inspections: same as ownerBilling: same as owner Legal/Enforcement Actions: same as owner5. Design Capacity Information (attach documentation showing vested capacity, i.e., land use permit, system design, etc.)Maximum Fermentation CapacityMaximum Barrel Storage Capacity6. Additional Questions:Gallons per year (maximum current facility design)Gallons (maximum barrel storage capacity at any time)a. Direction and straight line distance to nearest school: feet School Name:b. Straight line distance to nearest residence: feetc. Straight line distance to nearest offsite workplace: feetd. Do you claim that any of data submitted with this application is a trade secret? Yes Noe. Is the wine operation approved by a city/county/other planning agency? Yes No(CONTINUED ON NEXT PAGE)(District Use Only)Date Received Stamp APCD Application Auth. to Construct Permit to OperateNumber: Issuance Date: Issuance Date:Fee: Fee: Fee:Check No. Check No. Check No.Receipt No. Receipt No. Receipt No.Ref. App. No. Extended Permit No.Comments:Previous No.Page 1 of 4 Oct. 2011

3433 Roberto Court, San Luis Obispo, CA 93401Phone: (805) 781-5912 FAX: (805) 781-1002Email: info@slocleanair.orgWeb Site: www.slocleanair.orgWINE OPERATION PERMIT APPLICATION FORM (continued)7. Stationary Engines 50 Hp and Larger (If applicable)(For multiple engines that are not identical, attach the following information for each engine.)Manufacturer: Model: Serial No:Engine Size bhp @ rpm Year of Mfg. Year of installationNumber identical enginesEPA certification No., if known:Generator Mfg: Model: Rating: kWType of Use:direct-drivefire pump backup generator Other (specify)8. Hot Water Heater And Boiler Data For Units Rated At 500,000 Btus/Hr and Larger(For multiple boilers that are not identical, attach the following information for each boiler)Boiler Manufacturer: Model: Serial No:Burner Manufacturer Model: Serial No:Heat Input Rating (mmBtu/hr) Fuel type Year of Mfg. Year of InstallationNumber of Identical Boilers9. Historical Storage and Fermentation DataYear:White Wine Fermentation(gallons)Red Wine Fermentation(gallons)Peak wine volume stored in Barrels at anytime during the year (gallons)20052006200710. Tank Data attached Yes (note form is required)I hereby certify that all information provided on this application, and its plans, attachments, and supplemental forms, istrue and correct. I agree to pay any and all fees required by District rules for processing this application and forissuance of any Authority to Construct or Permit to Operate. If I abandon this project and withdraw my application, orshould my application be disapproved, I agree that the obligation exists to compensate the District for time spentprocessing my application.11 SIGNATURE: 12. DATE:13. PRINT NAME:14. ORGANIZATION:H:\ENGINEER\FORMS\On-Line\GeneralForms\Winery_App_2011.doc Page 2 of 4 August 2011

WINE OPERATIONS PERMIT APPLICATIONTANK DATAWinery Fermentation and Storage Aging Tanks Application FormTANK DATA: Provide the data below for each tank in the facility by inputting the data items noted below into the corresponding field in the table below andprovide a plot plan of the facility, indicating location of the tanks by Tank ID Number.Note: Plot and plan should include barrel storage area (ft 2 ).Data Item Data Description DirectionsA Tank I.D. No. Input the Facility's I.D. # for this tankB Tank Capacity, gal. Tank working capacity in gallonsCDTank Diameter, ftTank Height, ftE Tank Roof Design "open" or "closed"F Is Tank Insulated? "Yes" or "No"G Tank Construction Materials "steel", "concrete", "plastic", etc.HITank UseEquipped with Pressure Relief Valve(PRV) or Breather Vent?"red fermentation", "white fermentation", "storageonly", or combinations of these as appropriate"Yes" or "No"J Other Data Input any other relevant dataSUPPLEMENTAL WINERY SHEET #1Winery Tank Data TableA B C D E F G H I JTankI.D.TankCapacityGallonsTank Dia.ftTankHeight ftTank RoofDesignInsulated?Tank ConstructionMaterialsTank Use PRV? Other DataPage 3 of 4 Oct. 2011

WINE OPERATIONS PERMIT APPLICATIONTANK DATAA B C D E F G H I JTankI.D.TankCapacityGallonsTank Dia.ftTankHeight ftTank RoofDesignInsulated?Tank ConstructionMaterialsTank Use PRV? Other DataPage 4 of 4 Oct. 2011