National Pollutant Discharge Elimination System (Npdes) Stormwater Notice Of Termination Form - Florida Department Page 2

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IV. CERTIFICATION
:
I certify under penalty of law that all stormwater discharges associated with industrial or construction activity from the identified
facility or project that are authorized by the referenced State of Florida generic permit have been eliminated; the facility no longer
meets the conditional exclusion for “no exposure” outlined in paragraph 62-620.100(2)(o), F.A.C.; or that I am no longer the operator
of the facility or project. I understand that by submitting this Notice of Termination, I am no longer authorized to discharge
stormwater associated with industrial or construction activity under a generic permit, and that discharging pollutants in stormwater
associated with industrial or construction activity to surface waters of the State is unlawful unless authorized by a permit issued
pursuant to Section 403.0885, F.S. I also understand that the submittal of this Notice of Termination does not release an operator from
liability for any violations of their generic permit or conditional exclusion for “no exposure” from NPDES stormwater permitting for
industrial activities.
Responsible Authority Name and Official Title (Type or Print):
_________________________________________________________________
___________________________________
Responsible Authority Signature:
Date Signed:
1
Signatory requirements are contained in Rule 62-620.305, F.A.C.
Page 2 of 4
DEP Form 62-621.300(6)
Effective Date: 02/2015

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