DERR-2024-013270

NOT'Notice of Termination (NOT) for C)overage Undel the UPDES Gcnclal Pclmit for fleated
Grounclwatcr, UPDES Permit No.UTG790000.
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L Facility/Operator Information
UPDES Permit No.UTG790000 Coverage No.ijl rt:l
Name and location of facility (lnclude County narnc)
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Facility rnailing address (if diff'ercnt fi'onr physical address)
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Telephone Number [i (] l * :1 62 "' 19'] t)Narne of Operator '.i'irc 01,iie r-' Ii i d<l V j J. J..;'iqt:
Subrnission of this NOT constitutes notice that the operator/facility identificd in sectiou I olthis lonn is no longer
covered under thc UPDES General Pcnlit fbr''lreated Groundwater u PDES Pcrnrit No.tJT(i790000.
Il, Rcason for the Termination of Permit Coverage
Reason for pennit termination (attach additional sheets if nccessary)
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Where to File the NOT Form:
Division of Water Quality
195 North 1950 West
P.O. Box 144870
Salt Lake Citv, UT 84114-4870
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III. Certification
I certifu under penalty of law that all construction dervatering and/or hydlostatic tcsting opcrrrtions at the above
facility that were autholized by the UPDES General Pcrmit for Treated Gloundwater, UPDES Perrnit
No.U IG790000 have been elirninated or that I am no longer the operator ofthc facility. I undelstand that by
submitting the Notice of Termination, I am no longer covt:rcd under the general permit. I also understand that thc
subrnittal of this notice of tennination does not relcase au operator fiorn liability fol any violations of this permit or'
the Water Quality Act.
Date(mm/dd/yy)/.
Name (print)'ti xt S t",.r Title Cl;:(.), ,ilirr-: (jt..iti,,rr iiicio l\ca<1<:my
11 /08 t2024Signature
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