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Home My WebLink AboutDWQ-2023-200083STATE OF UTAH, DEPARTMENT OF ENVIRONMENTAL QUALITY, DIVISION OF WATER QUALITY195 North 1950 West, P.O. Box 144870, Salt Lake City, Utah 84114-4870(801)536-4300 NOINotice of Intent (NOI) for Coverage Under the UPDES Multi-Sector General Permit for Storm Water Discharges Associated with Industrial Activity No. UTR000000SEE PAGE 3 FOR INSTRUCTIONS Submission of this Notice of Intent constitutes notice that the party(s) identified in Section I of this form intends to be authorized by a UPDES permit issued for storm water discharges associated with industrial activity in the State of Utah.Becoming a permittee obligates such discharger to comply with the terms and conditions of the permit.ALL NECESSARY INFORMATION MUST BE PROVIDED ON THIS FORM. A different NOI form is provided for construction activities.Have stormwater discharges from your project/site been covered previously under an UPDES permit?YN If yes, what is the most current UPDES Permit Number? Permit No. UTR_____________________Has the SWPPP been prepared in advance of filling this NOI as required?YN SWPPP must be prepared prior to filling the NOI. Is the facility located in Indian Country?YN If yes, do not complete this NOI; instead submit an application for coverage under a storm water permit to EPA Region VIII (EPA form 3510-6).I.OWNER INFORMATION□Check here if Operator Information is the same as Owner Information Owner Name:________________________________________________Status of Owner(circle one):Federal Public State Private Address:______________________________________________________________________________ City:____________________________________________State:______Zip:________________ OWNER POINT OF CONTACT INFORMATION: First Name:__________________________Last Name: _____________________________Phone:_____________________________ Title: __________________________________________________Email: ____________________________________________________ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ OPERATOR INFORMATION(Do not fill out if Operator is same as Owner) Operator Name: ________________________________________________________________________ Mailing Address:_______________________________________________________________________ City:____________________________________________State:______Zip:________________ OPERATOR POINT OF CONTACT INFORMATION: First Name:__________________________Last Name: _____________________________Phone:_____________________________ Title: __________________________________________________ Email: ____________________________________________________II.FACILITY SITE/LOCATION INFORMATIONFacility Name:_______________________________________________________________________________ Address:_______________________________________________________County:____________________________ City:___________________________________________________________State:_____Zip:_________________ Latitude: _______________________Longitude: ______________ ______ Specify Coordinate System (circle one): Decimal Degrees or Degrees Minutes Seconds Is your facility presently inactive and unstaffed?*YN *Note that if your facility becomes inactive and unstaffed during the permit term, you must submit an NOI modification to reflect that change.The General Multi-Sector Permit covers all industrial activity that is required by law to be covered by a storm water permit. Please select each sector that covers industrial activities which occur at your site. The sector covered in Sector AD is the catch-all sector and should only be used if positively no other sector covers your industrial activity. If you should select AD, please call the Storm Water Coordinator at DWQ to discuss the need for choosing Sector AD (Non-Classified Facilities).Primary Regulated Sector: ______Primary SIC Code: __________________Co-Located Sector: _________Co-Located SIC Code: _____________________Co-Located Sector: _________Co-Located SIC Code: _____________________Co-Located Sector: _________Co-Located SIC Code: _____________________ IV.SITE ACTIVITY INFORMATION Municipal Separate Storm Sewer System (MS4) Operator Name:____________________________________________□N/A Receiving Water Body:_____________________________________ (see http://wq.deq.utah.gov/) Effluent Limitation Guidelines:Identify any Effluent Limitation Guideline(s) for your sector that apply to your stormwater discharges (Appendix I of the MSGP > applicable sector > Part E.2 - Numeric Effluent Limitations). Write it below. (Write “Not Applicable” if there are no Effluent Limitation Guidelines for this Sector). ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Is the facility required to do analytical benchmark monitoring (See Appendix I > applicable sector> Part E.1 – Analytical Benchmark Monitoring) YesNo Is there existing quantitative stormwater discharge data?YesNo List all other UPDES permits at the site (if applicable):____________________________________________________________ V. CERTIFICATION I certify under penalty of law that this document and all attachments were prepared under my direction or supervision, in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted.Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.Signature: ___________________________________________________________________Date: ______________________________Print Name: ________________________________________________________________________________________________________Title: _______________________________________________________________________ Amount of Permit Fee Enclosed:$______________ INSTRUCTIONSNotice of Intent (NOI) For Permit Coverage Under the UPDES Multi-Sector General Permit (MSGP) Who Must File A Notice Of Intent (NOI) FormState law at UAC R317-8-11.3(1) prohibits point source discharges of storm water associated with industrial activity to a water body(ies) of the State without a Utah Pollutant Discharge Elimination System (UPDES) permit.The operator of an industrial activity that has such a storm water discharge must submit a NOI to obtain coverage under the UPDES Multi-Sector Storm Water General Permit.If you have questions about whether you need a permit under the UPDES Storm Water program, or if you need information as to whether a particular program is administered by EPA or a state agency, contact the Storm Water Section of the Division of Water Quality at (801) 536-4300.Pollution Prevention PlanA storm water pollution prevention plan (SWPPP) is required to be in hand before the NOI can be submitted.It is important to know SWPPP requirements (contained in the permit) even during the design portion of the project.A copy of the permit can be obtained from the Division of Water Quality’s storm water industrial web site. Guidance material for developing a SWPPP can be obtained from the Division of Water Quality’s storm water industrial web site.Where To File NOI FormThe preferred method of submitting a NOI is by completing a NOI electronically on the NPDES eReporting Tool (NeT) Storm Water Database: https://cdx.epa.gov/ . If you submit a waiver from electronic reporting, in accordance with Part I.I of the permit, you may also submit a paper form to the following address:Department of Environmental QualityDivision of Water QualityP.O. Box 144870Salt Lake City, UT84114-4870Beginning of CoveragePermit coverageis issued immediately after submitting an NOI with the permit fee.The permittee should be aware that though you may not have a permit in hand, if you have submitted a completed NOI with the permit fee you are covered by the conditions in the permit and will be expected to comply with permit conditions.You can print a copy of the Multi-Sector General Permitand the applicable sector requirements from the DWQ Storm Water web site:https://deq.utah.gov/water-quality/general-multi-sector-industrial-storm-water-permit-updes-permitsPermit Fees.The permit fee is $250.00 per calendar year and is prorated by quarter.The yearly fee is due by December 31st each year to maintain an active status. Permit coverage will not be issued until the fee is paid.Application DateFee DueJanuary – March$250.00April – June$187.50July – September$125.00October – December$312.50**fee includes payment for current quarter and following year ($62.50+$250)General InformationThe Storm Water General Permit for Industrial Activities UTR000000 will expire on December 31, 2028. The Clean Water Act requires that all UPDES permits be renewed every 5 years.If permit coverage extends beyond the expiration date of the permit, permit coverage must be renewed to continue coverage under the renewed permit that will subsequently be developed to continue the same or similar permit for industrial activity.SECTION I – OWNER AND OPERATOR INFORMATIONSupply the legal name(s) of the person(s), firm(s), public organization(s), or any other entity(ies) that qualifies as the owner of the project (see permit definitions). Do the same for the operator that conducts facility operations at the permitted site. The owner and the operator of the project may be the same.Enter the complete address and telephone number of the owner and operator and a point of contact person and number for each.SECTION II – FACILITY INFORMATIONEnter the facility name of the site and complete street address, including city, county, state and ZIP code.The latitude and longitude of the facility must be included to the approximate center of the site. Specify which coordinate system is used, either Decimal Degrees or Degrees Minutes Seconds. Mark if the facility is presently inactive and unstaffed. Note that if your facility becomes inactive and unstaffed during the permit term, you must submit an NOI modification to reflect that change.SECTION III – SECTOR IDENTIFICATIONList in descending order of significance, your facility’s applicable sectors and standard industrial classification (SIC) codes that best describe the principal products produced or services provided. For industrial activities defined in UAC R317-8-11.3(6)(d) that do not have SIC codes that accurately describe the principal products produced or services provided, the following 2-character codes are to be used:HZ =Hazardous waste treatment, storage or disposal facilities, including those that are operating under interim status or a permit under subtitle C of RCRA [UAC R317-8-11.3(6)(d)(4)];LF =Landfills, land application sites and open dumps that receive or have received any industrial wastes, including those that are subject to regulation under subtitle D of RCRA [UAC R317-8-11.3(6)(d)(5)];SE =Steam electric power generating facilities, including coal handling sites [UAC R317-8-11.3(6)(d)(7)];TW =Treatment works treating domestic sewage or any other sewage sludge or wastewater treatment device or system, used in the storage, treatment, recycling, and reclamation of municipal or domestic sewage [UAC R317-8-11.3(6)(d)(9)];SECTION IV – SITE ACTIVITY INFORMATIONIf the storm water discharges to a municipal separate storm sewer system (MS4), enter the name of the operator of the MS4 (e.g., the name of the City or County of jurisdiction) and the receiving water of the discharge from the MS4. You can also look up the closest water body at http://wq.deq.utah.gov to identify your receiving water. A municipal separate storm sewer system is defined as a conveyance or system of conveyances (including roads with drainage systems, municipal streets, catch basins, curbs, gutters, ditches, man-made channels, or storm drains) that is owned or operated by a state, city, town, county, district, association or other public body which is designed or used for collecting or conveying storm water.Identify the Federal Effluent Limitation Guidelines for the sector(s) under which your facility is classified. Guidelines can be found for each sector by going to Part E.2 of the applicable Appendix I for Monitoring Requirements in the MSGP found on the industrial web page at stormwater.utah.gov. Determine if your storm water discharges are subject to the guidelines.To answer the questions concerning analyticalbenchmark monitoringexamine Part E.1 of the applicable Appendix I in the MSGP.Indicate whether or not the owner or operator of the facility has existing quantitative date that represents the characteristic and concentration of pollutants in storm water discharges.If there are other UPDES permits presently issued for the facility list the permit numbers. If an application for the facility has been submitted but no permit number has been assigned, enter the application number. SECTION V – CERTIFICATIONState statutes provide for severe penalties for submitting false information on this application form.State regulations require this application to be signed as follows:For a corporation:by a responsible corporate officer, which means: (i) president, secretary, treasurer, or vice-president of the corporation in charge of a principal business function, or any other person who performs similar policy or decision making functions, or (ii) the manager of one or more manufacturing, production, or operating facilities employing more than 250 persons or having gross annual sales or expenditures exceeding $25 million (in second quarter 1980 dollars), if authority to sign documents has been assigned or delegated to the manager in accordance with corporate procedures; For a partnership or sole proprietorship: by a general partner or the proprietor; orFor a municipality, state, Federal, or other public facility: by either a principal executive officer or ranking elected official.