121 E MARINE VIEW DR 2016-01-01 MF Import

' . - Instructions for Completing the Notice of Termination Form ' For the Baseline General Permh to Discharge Storm Water Associated with Construction Activity This is an instruction document for preparing a Notice of Termination (NOT) for coverage under the Baselin� General Permit for the discharge of scormwater associated v�ith conrnuction activity. Where all stormwater discharges from a construction site have been eliminated and the site has undergone final scabilization, the pemi�:tee of the site shall submit a Notice oi Termination to the Department o1 Ecology. The permit fees will continue until this notice is received by Ecology. Instructions tor Completing the Notice of Termination Form Please complefe the document by prinling or ryping the in/onnatinn in ink. 1. Permit Number Fost the permit number shown in the upper right hand corner of your permit on this NOT. 2. Contact Person ISection 1.1 Give the name, address, and telephone number of the person who is available 24 hours a day for contact by Ecology or other locel auihorities. The contact person should be someone who is completely familiar with the site, and charged with overseeing compliance with the permh requirements. 3, OwnerlRepresentative of Site Give the name, and the address of the person, company, firm, public (Section II.1 corporation, rnunicipality or any other entity which owns or legally represents the site. lt the owner is the same as the contact oerson. enter 'same as contaci' on the first line. 4. Site Address ISection III.) Enter the street address or location description, including the city or nearest crty and counry for the construction site. Conscruction site which do not have a stteet address must also provide a legal description in the space provided or as an attachment. 5. Billing Address ISection IV.) I�dicate where the final fee invoice sfiould be sent. 6. Construction Activity Indicate that all stormwriter discharges associaced with conscruc[ion (Section V.1 activity have been eliminated, and final stahilization of all e�cposed soiis through vegetation or other measures has been completed. 7. Certification ot Permitteelsl This statement should be read carefully by the permittee(s). The responsible o�ciai or authorized representative of the owner shall princ tfieir names for claritY, then sign and date the docurnent on the lines provided. Refer to General Condition G20 in the permit for signatory requirements. Address to Submit the NOT Notices of Termination are to be sent, using the Construction Activity NOT form included in the permit as Appendix 2, to the following address: Department of Ecology Industrial Storm Water Unit P.O. Box 47695 Olympia, WA 98504-7696 Questions Questions conceming proper completion of this form can be directed to the Department of Ecology by calling (3601 407-6437 eF-49�-643fr.