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0 REQUEST FOR RENEWAL <br /> � ot Coverege Under the General Permit to - - - - - - <br /> Discharge Stotmwater Associated with permit k S03 - <br /> """"" ""' Construction Activity <br /> , � ,,,� .� �, „ <br /> ECOIOCY <br /> This Form Shouid Oniv Be Filled Out and Submitted to Ecology 1f <br /> Construction Activ'rty 1M11 CoMinue Past May 23, 2000. <br /> DO NOT SUBMff THiS FDRM SOONER THAN APR1123.7A00. OR LATEA THAN MAY 23. 2000, AND ONLY <br /> SUBMR THIS FORM IF CONSTRUCTION WILL CONTINUE PAST MAY 23, 2000. <br /> Duty to Reapply: <br /> General Condition G15 oi the construction general permit requires permittees to reappFy for coverage under tihe <br /> construction general permit. at least 180 days prior to the expiraaon date �f tf�e pertnit or November 18, 2000. <br /> This requirement is only necessary for ifiase projects thal will be active pas[the renewal date of <br /> Mav 23, 2000. This form is being provided as a corrvenient reminder and metl. .f to accomplish 2his <br /> reqiiirement <br /> IPlease print in ink or type) <br /> I. Contact Person II. Owner/Representative of Site <br /> Contact Name Phone No. Owner's Name Phone No. <br /> Company Company Name <br /> Mailing Address Mailing Address <br /> ��ry State Zip + 4 City State Zip . 4 <br /> III. Site Location/Address IV. Billin Address <br /> Site Name Contaet Name Phone No. <br /> Street Address lor Location Descriptionl Company Name <br /> City lor nearest city) Zip + 4 Mailing Address <br /> County C'rty State Zip + 4 <br /> Provide Iegal description 'rf no address for site (attach separate sheet rf necessaryl <br /> V. Construction Activity <br /> Has the construction projett terminated and the site undergone final stabilizadon with all stortnwater discharges <br /> from consttuction activities that are authorized by this permit eliminated? 0 Yes 0 No <br /> If the answer is YES, please refer to Appendix 2 of your permn for a Notice of Termination (NOTj torm to end <br /> permit coverage. Permit fees will continue until tfie NQT form is received by Ecology. <br /> If the answer is N0, indicate the target date for conmuction completion: / <br /> AnUclpated CanswcUan Completion Date <br /> fContinued on Back Pagel <br /> (Rev. 77/95) (Appendix 3) <br />