Notice Of Termination Form (Not) printable pdf download

NOTICE OF TERMINATION FORM (NOT)

To Relinquish the Authorization to Discharge

Stormwater Runoff from Industrial Activity

from the Industrial Facility Described Herein.

Kansas Water Pollution Control General Permit No. S-ISWA-0507-1

Submission of this Notice of Termination (NOT) constitutes notice that the party identified in Section I of this form relinquishes

authorization for coverage under the Kansas Water Pollution Control general permit, or KDHE authorized successors, issued for

Stormwater Runoff from Industrial Activity in the State of Kansas. Submission of this Notice of Termination to KDHE relinquishes the

permittee=s authorization to discharge stormwater associated with industrial activity at the industrial facility described herein. Completion

of this NOT does not automatically relieve the former permittee of any civil, criminal and/or administrative penalties.

Coverage is terminated when the Kansas Department of Health and Environment (KDHE) receives a complete NOT. For transfer of

ownership, coverage is terminated when KDHE receives a complete NOT and a complete NOTO for the industrial facility, and KDHE

authorizes the transfer. To be considered complete, the NOT and the NOTO must be signed by the relinquishing permittee or a duly

authorized representative of the relinquishing permittee, and must include the permit number assigned to the industrial facility. The new

permittee or duly authorized representative must also sign the NOTO. KDHE will notify any permittee whose NOT is incomplete, deficient

or denied.

Certification

I certify under penalty of law that all authorized discharges of stormwater associated with industrial activity at the industrial facility

described herein have been eliminated; or the permittee named herein is no longer the owner or operator of this industrial facility. I

understand that by submitting this Notice of Termination, I am no longer authorized under the general NPDES permit S-ISWA-0507-1 to

discharge stormwater associated with industrial activity at this industrial facility. I understand that discharging pollutants in stormwater

associated with industrial activity to waters of the State is unlawful under K.S.A. 65-164 and 65-165 and the Clean Water Act without

authorization by a valid Kansas Water Pollution Control Permit. I understand that by submitting this Notice of Termination, I am not

released from liability for any violations of the general NPDES permit S-ISWA-0507-1, K.S.A. 65-164 and 65-165, the Kansas Surface

Water Quality Standards (K.A.R. 28-16-28 et seq.), or the Clean Water Act. When ownership of the entire industrial facility is being

transferred, I understand that the transfer of permit responsibilities is effective when KDHE confirms the transfer. I also hereby certify that

I am authorized to sign this Notice of Termination as a representative of the permittee named herein.

Please Print or Type.

Name of Industrial Facility: ____________________________________________________________

Address: ________________________________City:__________________ County: ____________ State: KS Zip Code: _______

Kansas Permit No._________________________________

Federal Permit No.__________________________________________

Print Name: ___________________________________________

Date: _________________________________________

Signature: _____________________________________________

E-mail address: _________________________________

This Notice of Termination is being submitted because:

The industrial facility is inactive/abandoned and no longer has stormwater discharges from the facility that meet the

definition of stormwater discharges associated with industrial activity. No significant materials remain at the site and

production has ceased. (See Part 1.8 of the general NPDES permit).

Ownership of the site has changed. [The relinquishing permittee shall submit an NOT and a copy of the Notice of

Transfer of Ownership (NOTO).]

Submit the NOT (and NOTO if applicable) with original signature to:

KDHE Contact Information

Kansas Department of Health and Environment

Phone: (785) 296-5545

Bureau of Water, Industrial Programs Section

e-mail: stormwater@kdhe.state.ks.us

1000 SW Jackson, Suite 420

Topeka, KS 66612 - 1367

Effective September 1, 2006

Notice of Termination (NOT)

Notice Of Termination Form (Not)

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