DEQ Form 606-006 "Notice of Certification of Industrial Existence (Ncie) for Stormwater Discharges Associated With Industrial Activity Under the Opdes Multi-Sector General Permit Okr05" - Oklahoma

What Is DEQ Form 606-006?

This is a legal form that was released by the Oklahoma Department of Environmental Quality - a government authority operating within Oklahoma. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 5, 2017;
  • The latest edition provided by the Oklahoma Department of Environmental Quality;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of DEQ Form 606-006 by clicking the link below or browse more documents and templates provided by the Oklahoma Department of Environmental Quality.

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Download DEQ Form 606-006 "Notice of Certification of Industrial Existence (Ncie) for Stormwater Discharges Associated With Industrial Activity Under the Opdes Multi-Sector General Permit Okr05" - Oklahoma

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Oklahoma Department of Environmental Quality
DEQ Form
Notice of Certification of Industrial Existence (NCIE)
606-006
for Stormwater Discharges Associated with Industrial Activity
July 5, 2017
under the OPDES Multi-Sector General Permit OKR05
Submission of this certification gives notice that the party identified on this Form intends to be authorized by DEQ
for stormwater discharges associated with industrial activity located within a watershed designated as
Outstanding Resource Water and/or Scenic River within the State of Oklahoma.
This form must be completed with all the pertinent information.
I. Facility Information
Facility Name:
_________________________________________________________________________
Address:
____________________________________________________________________________
City:
County:
_____________________________
________________________________
OK
State:
Zip Code:
_________
______________________
Latitude:
Longitude:
____________________________
_____________________________
Quarter:
Section:
Township:
Range:
_____________________
___________
___________
____________
Facility’s Point of Contact :
Title:
___________________________________________
___________________________
Phone:
E-mail:
______________________________
_________________________________________________
II. Existence Statement
The industrial entity listed in Section I has been in continuous operation at the stated location beginning on or
before June 25, 1992.
Yes
No
III. Certification
I certify under penalty of law that the information contained in this document and all attachments was prepared
under my direction or supervision in accordance with a system designed to assure that qualified personnel properly
gathered and evaluated 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.
Print Name:
Title:
_______________________________________________
___________________________________
Signature:
Date:
___________________________________________
______________________________
OKR05
For DEQ use only: Assigned Authorization Number:
___________________
Oklahoma Department of Environmental Quality
DEQ Form
Notice of Certification of Industrial Existence (NCIE)
606-006
for Stormwater Discharges Associated with Industrial Activity
July 5, 2017
under the OPDES Multi-Sector General Permit OKR05
Submission of this certification gives notice that the party identified on this Form intends to be authorized by DEQ
for stormwater discharges associated with industrial activity located within a watershed designated as
Outstanding Resource Water and/or Scenic River within the State of Oklahoma.
This form must be completed with all the pertinent information.
I. Facility Information
Facility Name:
_________________________________________________________________________
Address:
____________________________________________________________________________
City:
County:
_____________________________
________________________________
OK
State:
Zip Code:
_________
______________________
Latitude:
Longitude:
____________________________
_____________________________
Quarter:
Section:
Township:
Range:
_____________________
___________
___________
____________
Facility’s Point of Contact :
Title:
___________________________________________
___________________________
Phone:
E-mail:
______________________________
_________________________________________________
II. Existence Statement
The industrial entity listed in Section I has been in continuous operation at the stated location beginning on or
before June 25, 1992.
Yes
No
III. Certification
I certify under penalty of law that the information contained in this document and all attachments was prepared
under my direction or supervision in accordance with a system designed to assure that qualified personnel properly
gathered and evaluated 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.
Print Name:
Title:
_______________________________________________
___________________________________
Signature:
Date:
___________________________________________
______________________________
OKR05
For DEQ use only: Assigned Authorization Number:
___________________