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
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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:
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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