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DocuSign Envelope ID:AB1F1251-4FB8-4A36-85F 15A9B6A8662 San Joaquin Valley 0 IV AIR POLLUTION CONTROL DISTRICT HEALTHY AIR LIVING'- Wood-Burning Heater Statement of Compliance 22370 N BEZLEY RD CLEMENTS CA 95227 Property Address City State Zip SAN JOAQUIN 019-260-54 County Assessor Parcel Number(APN) Section 5.2 of Rule 4901—Wood-Burning Fireplaces and Wood-Burning Heaters, requires an wood-burning heater(stove or fireplace insert) included with the sale or transfer of real property to be EPA Phase II certified. Any non-certified wood- burning heater must be removed from the property or rendered permanently inoperable prior to the close of escrow. There are no restrictions on the sale or transfer of property with open-hearth masonry or zero-clearance fireplaces, pellet stoves, or wood-burning cook stoves with ovens.A certified heater should have a permanent label attached that indicates that the heater meets July 1, 1990, emissions standards.A list of certified heaters is maintained at: http://www.epa.goy/Compliance/resources/publications/monitoring/caa/woodstoves/certifiedwood.pdf. Sellers are required to complete this form whenever a wood-burning stove or insert is included with the property. A copy shall be mailed or faxed to the San Joaquin Valley Air Pollution Control District within 30 days of close of escrow. Seller Disclosure Seller represents that the subject property will meet the following requirements of Section 5.2 of District Rule 4901 at the close of escrow: That any woodstoves or fireplace inserts included in the property are EPA Phase 11 certified and that any non-certified woodstove or insert has been removed from the property or rendered permanently inoperable (indicate or explain how below): ❑ EPA Certified (provide): Year: Make: Model: ❑ Removed (explain): ❑ Rendered Inoperable (explain): Seller 1: NOT APPLICABLE Signature Print Name Date Seller 2: Signature Print Name Date The undersigned hereby acknowledges receipt of a copy of this document. Buyer 1: Signature Print Name Date Buyer 2: Signature Print Name Date WARNING: It is unlawful to sell any wood-burning heater that is not EPA certified. This includes, but is not limited to thetransfer through a real estate transaction. This transaction is subject to an audit by the San Joaquin Valley Air Pollution Control District for compliance. For more information please contact: San Joaquin Valley Air Pollution Control District 1990 East Gettysburg Avenue Fresno, California 93726 PH: (559)230-6000 1 FAX.(559) 230-6062 www.val eyair.orq For your convenience, you may email the completed form to: wbcompliancestatement anvallevair.ora ❑District Copy ❑Seller's Copy ❑ Buyer's Copy Revised 11!2015