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Sac Metro Air District

777 12th Street, Ste. 300, Sacramento CA 95814, US


Check Before you Burn Exemption Request

Use this form to request an exemption from Section 301 of Sacramento Metropolitain Air Quality Management District Rule 421, Mandatory Episodic Curtailment of Wood and Other Solid Fuel Burning.

All information submitted with this form will remain confidential to the extent permitted under the California Public Records Act (§ 6250).

Applicant Name

Property Address

Reason for Exemption

Please upload a recent repair or replacement estimate from a licensed company

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Gross Monthly Household Income

Total amounts for all people in the household.

Please upload copies of income documentation (paystubs, benefit letters, tax forms, etc.) for everyone living in your home

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Please upload last paid utility bill(s).

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I certify the information contained in this application is accurate to the best of my knowledge under penalty of perjury under the laws of the State of California. I authorize an inspector from Sacramento Metropolitain Air Quality Management District to inspect my residence to verify these statements.

Applicant Signature

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Updated October 2020