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HomeMy WebLinkAboutDWQ-2024-0073391 UPDES Permit UTS000001 for Discharges from Jordan Valley Municipalities NOT Notice of Termination (NOT) for Coverage Under the UPDES Permit UTS000001 for Discharges from Jordan Valley Municipalities This form is to be submitted when this permit is no longer required or necessary, and new permit coverage has been obtained under a new permit number. You must type of print legibly, forms that are not legible or are unsigned will be returned. Do not leave blank spaces. It is recommended that you maintain a copy of the completed form for your records. Part I. Permit Information UTR09New UPDES Permit Number: Previous Permit Number: Basis for terminating permit coverage: Part II. Facility Information Facility Name: Mailing Address: Street (PO Box): City: State: Zip: Phone: Email: Facility Location (if different from mailing address): Street (PO Box): City: State: Zip: Part III. Facility Contact/Operator Name: Title: Phone: Email: UTS000001 2 Part IV. Certification Information All Applicants Must Complete the Following Certification I certify under penalty of law that all MS4 permitting operations at the above facility that were authorized by the UPDES Permit UTS000001 for Discharges from Jordan Valley Municipalities have been eliminated or covered under another UPDES permit. I understand that by submitting the Notice of Termination, I am no longer covered under this permit. I also understand that the submittal of this notice of termination does not release an operator from liability for any violations of this permit of the Water Quality Act. Printed Name: Title: Signature: Organization: Date (mm/dd/yy): Email: 3 Instructions for Completing a Notice of Termination Form (NOT) for the UPDES Permit UTS000001 for Discharges from Jordan Valley Municipalities Permit Who May File an NOT Form: Permittees with an active coverage under the Utah Pollutant Discharge Elimination System (UPDES) Permit UTS000001 for Discharges from Jordan Valley Municipalities may submit a NOT form when coverage is no longer needed, and new coverage has been obtained. Only those permittees who submit an NOI to receive discharge authorization are required to submit an NOT. Completing the Form Type or print, in the appropriate areas only. “NA” can be entered in areas that are not applicable. If you have any questions about how or when to use this form, contact the Division of Water Quality. Part I. Permit Number Enter the existing UPDES Permit Coverage Number for the MS4 permittee assigned at the time the Notice of Intent (NOI) was submitted. If you do not know the coverage permit number, you can find contact the Division of Water Quality. Part II. Facility Information Provide the Facility Name described in the NOI and is covered by the permit coverage number identified in Part I. The entity responsible for the Municipal System operations is the legal entity that controls the site operation, rather than the facility manager. Enter the Facility complete mailing address, telephone number and email address. Include the physical facility location if different from the mailing address. Part III. Facility Contact/Operator Enter the MS4 operator or main contact for the MS4. If there are any other operators or site managers these maybe included here. A facility contact must be provided for termination of permit coverage to be valid. Part IV. Certification Information The NOTs, must be signed as follows: 1)For a corporation, a responsible corporate officer shall sign the NOT, a responsible corporate officer means: a.A 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 for the corporation; or b.The manager of one or more manufacturing, production, or operating facilities, if i.The manager is authorized to make management decisions that govern the operation of the regulated facility, including having the explicit or implicit duty of making major capital investment recommendations, and initiating and directing other comprehensive measures to assure long term environmental compliance with environmental statutes and regulations: ii.The manager can ensure that the necessary systems are established or actions taken to gather complete and accurate information for permit application requirements; and iii.Authority to sign documents has been assigned or delegated to the manager in accordance with corporate procedures.2)For a partnership of sole proprietorship, the general partner or the proprietor, respectively; or 3)For a municipality, state or other public agency, either a principal executive officer or ranking elected official shall sign the application; in this subsection, a principal executive officer of any agency means;a.The chief executive officer of the agency; orb.A senior executive officer having responsibility for the overall operations of a principal geographic unit or division of the agency. Include the name, title, and email address of the person signing the form and the date of signing. An unsigned or undated NOT will not be considered valid terminated of permit coverage. You are required to comply with all conditions and reporting requirements until the NOT is submitted to DWQ. Where to File NOT form: Please submit the original form with a signature to the DWQ online portal https://deq.utah.gov/water-quality/water-quality- electronic-submissions or the below address. Remember to retrain a copy for your records. NOTs sent by mail: Division of Water Quality 195 North 1950 West PO Box 144870 Salt Lake City, UT 84114-4870