"Notice of Termination (Not) for AZPDES General Permits for Domestic Wastewater or Biosolids Preparation" - Arizona

Notice of Termination (Not) for AZPDES General Permits for Domestic Wastewater or Biosolids Preparation is a legal document that was released by the Arizona Department of Environmental Quality - a government authority operating within Arizona.

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NOTICE OF TERMINATION (NOT)
for AZPDES General Permits for Domestic Wastewater or
Biosolids Preparation
Submitting this NOT constitutes notice that the signer is terminating coverage under an AZPDES General Permit (AZGP) for
discharges of domestic wastewater or for biosolids preparation for the authorization number indicated. Unless notified otherwise by
ADEQ, authorization to discharge to waters of the U.S. under this permit terminates at midnight on the day the NOT is received by
ADEQ. To terminate your project, fax or submit a complete and accurate NOT to:
Arizona Department of Environmental Quality
Surface Water Section — Permits Unit
1110 West Washington, 5415A-1; Phoenix, Arizona 85007
FAX: (602) 771-4528
TYPE OF AZGP COVERAGE:
___
__ Infrequent Discharger
_
____ Minor WWTPs
_________ Biosolids
I. PERMIT INFORMATION
_____
_____
DAC Authorization Number:
_ Name of Facility:_
_
_____
Name of signer on Notice of Intent (NOI) submitted to ADEQ:
_
Business / Agency of signer on NOI submitted to ADEQ: __________________________________________________
II. COVERAGE IS BEING TERMINATED BECAUSE: (check those applicable to your situation)
The discharge and/or biosolids preparation has been terminated.
____
discharge and/or biosolids preparation was
____ No
conducted.
The discharge and/or biosolids preparation is covered under another AZPDES individual or general permit.
____
If checked, provide the permit number: ____________________________________
You are no longer the Owner/Operator of the facility or activity.
____
If checked, provide the following information concerning the new Operator/Owner:
Name and Firm/Agency: ___________________________________________________________________
Contact Person:____________________________________________ Phone: ________________________
Address/Location: ________________________________________________________________________
City: ________________________________________ State: |
|
| Zip Code:______________________
(Note: The new owner must submit an NOI to obtain coverage)
III. MONITORING REPORT (Submit all applicable reports)
Have all Discharge Monitoring Reports (DMR) and/or Biosolids Annual Reports been submitted?
Yes
No
____
____
If no, attach completed Discharge Monitoring Report (DMR) Form(s) and/or applicable Biosolids Annual Report.
IV. CERTIFICATION
“I certify under penalty of law that either all discharges and/ or biosolids operations associated with this facility have been
terminated or that I am no longer the responsible person for such discharges and/or biosolids operations. I understand that by
submitting this NOT, I am no longer authorized to discharge and/or operate biosolids treatment under the AZPDES General
Permit(s), and further, that such discharge is unlawful unless authorized under an AZPDES permit. I also understand that
submittal of this NOT does not release persons from liability for any violations of this permit or of the Clean Water Act.”
Printed Name: _____________________________________________ Title: ________________________________
Business / Agency: _____________________________________________ Phone: ___________________________
Signature: ____________________________________________________ Date: ____________________________
NOTICE OF TERMINATION (NOT)
for AZPDES General Permits for Domestic Wastewater or
Biosolids Preparation
Submitting this NOT constitutes notice that the signer is terminating coverage under an AZPDES General Permit (AZGP) for
discharges of domestic wastewater or for biosolids preparation for the authorization number indicated. Unless notified otherwise by
ADEQ, authorization to discharge to waters of the U.S. under this permit terminates at midnight on the day the NOT is received by
ADEQ. To terminate your project, fax or submit a complete and accurate NOT to:
Arizona Department of Environmental Quality
Surface Water Section — Permits Unit
1110 West Washington, 5415A-1; Phoenix, Arizona 85007
FAX: (602) 771-4528
TYPE OF AZGP COVERAGE:
___
__ Infrequent Discharger
_
____ Minor WWTPs
_________ Biosolids
I. PERMIT INFORMATION
_____
_____
DAC Authorization Number:
_ Name of Facility:_
_
_____
Name of signer on Notice of Intent (NOI) submitted to ADEQ:
_
Business / Agency of signer on NOI submitted to ADEQ: __________________________________________________
II. COVERAGE IS BEING TERMINATED BECAUSE: (check those applicable to your situation)
The discharge and/or biosolids preparation has been terminated.
____
discharge and/or biosolids preparation was
____ No
conducted.
The discharge and/or biosolids preparation is covered under another AZPDES individual or general permit.
____
If checked, provide the permit number: ____________________________________
You are no longer the Owner/Operator of the facility or activity.
____
If checked, provide the following information concerning the new Operator/Owner:
Name and Firm/Agency: ___________________________________________________________________
Contact Person:____________________________________________ Phone: ________________________
Address/Location: ________________________________________________________________________
City: ________________________________________ State: |
|
| Zip Code:______________________
(Note: The new owner must submit an NOI to obtain coverage)
III. MONITORING REPORT (Submit all applicable reports)
Have all Discharge Monitoring Reports (DMR) and/or Biosolids Annual Reports been submitted?
Yes
No
____
____
If no, attach completed Discharge Monitoring Report (DMR) Form(s) and/or applicable Biosolids Annual Report.
IV. CERTIFICATION
“I certify under penalty of law that either all discharges and/ or biosolids operations associated with this facility have been
terminated or that I am no longer the responsible person for such discharges and/or biosolids operations. I understand that by
submitting this NOT, I am no longer authorized to discharge and/or operate biosolids treatment under the AZPDES General
Permit(s), and further, that such discharge is unlawful unless authorized under an AZPDES permit. I also understand that
submittal of this NOT does not release persons from liability for any violations of this permit or of the Clean Water Act.”
Printed Name: _____________________________________________ Title: ________________________________
Business / Agency: _____________________________________________ Phone: ___________________________
Signature: ____________________________________________________ Date: ____________________________