National Pollutant Discharge Elimination System (Npdes) Stormwater Notice Of Termination Form - Florida Department

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NATIONAL POLLUTANT DISCHARGE
ELIMINATION SYSTEM (NPDES) STORMWATER
NOTICE OF TERMINATION
(RULE 62-621.300(6), F.A.C.)
You must use this form to terminate coverage under the Generic Permit for Stormwater Discharge from Large and Small Construction
Activities provided in subsection 62-621.300(4), F.A.C., the Multi-Sector Generic Permit for Stormwater Discharge Associated with
Industrial Activity provided in subsection 62-621.300(5), F.A.C. as well as the conditional exclusion for “no exposure” of industrial
activities and materials to stormwater provided in paragraph 62-620.100(2)(o), F.A.C.
All information provided on this form shall be typed or printed in ink.
I.
TERMINATION INFORMATION:
FLR
A. Facility ID/Project Numbe
r:
B. Reason for Termination:
Check all that apply:
No longer operator of the facility/project.
Final stabilization criteria is met and all stormwater discharges associated with construction activity including dewatering
operations have ceased (for construction activity only).
All stormwater discharges associated with industrial activity have ceased (for industrial activity only).
No longer meet the condition of “no exposure” (for industrial activity only).
II.
OPERATOR INFORMATION:
A. Operator Name
:
B. Addres
s:
C. City
:
D. State
:
E
. Zip Code
:
F. Responsible Authority:
G. Responsible Authority’s Phone No.
:
H. Responsible Authority’s E-mail Addres
s:
I.
Responsible Authority’s Fax No
.:
III. FACILITY/PROJECT INFORMATION:
A. Name
:
B. Address/Locatio
n:
C. City:
D. State:
E
. Zip Code
:
F. County
:
Page 1 of 4
DEP Form 62-621.300(6)
Effective Date: 02/2015

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