Form ECY070-30 "Sand and Gravel Permit Portable Completion of Operations Notice Form" - Washington

What Is Form ECY070-30?

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

Form Details:

  • Released on January 1, 2018;
  • The latest edition provided by the Washington State Department of Ecology;
  • 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 Form ECY070-30 by clicking the link below or browse more documents and templates provided by the Washington State Department of Ecology.

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Download Form ECY070-30 "Sand and Gravel Permit Portable Completion of Operations Notice Form" - Washington

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Sand and Gravel General Permit
Portable Completion of Operations Notice Form
Ecology must receive this notification form when all activities associated with the portable operation
have ceased, all equipment associated with the operation has been removed, all land affected by the
portable operation has been restored in accordance with S12.B.3 of the permit.
Please print in ink or type all sections of this application. All fields are required unless otherwise marked.
Permit Number
1.
– Provide your permit number.
Permit Number:
3. Site Contact
– Ecology may contact this person
2. Permittee Contact Information
regarding questions about the site restoration.
Organization Name – Provide the legal name of the
Site Contact First & Last Name:
business or company (Permittee):
Legal Responsible Party – Provide the first and last name
of the person who has the legal authority to represent the
Organization Name:
permittee and commit to the terms and conditions of the
permit:
E-mail:
Business Phone:
Business Phone:
E-mail (Optional):
Mailing Address:
Mailing Address:
City:
State:
Zip + 4:
City:
State:
Zip + 4:
Cell Phone (Optional):
Fax (Optional):
Cell Phone (Optional):
Fax (Optional):
4. Site Owner
5. Site Information
Site Owner First & Last Name:
Site Name:
Street Address:
Organization Name (Optional):
Mailing Address:
City:
Zip + 4:
City:
State:
Zip + 4:
Site’s Sand and Gravel General Permit Number
(if applicable):
Business Phone:
Cell Phone (Optional):
E-mail (Optional):
ECY 070-30 (Rev.01/18)
Sand and Gravel General Permit
Portable Completion of Operations Notice Form
Ecology must receive this notification form when all activities associated with the portable operation
have ceased, all equipment associated with the operation has been removed, all land affected by the
portable operation has been restored in accordance with S12.B.3 of the permit.
Please print in ink or type all sections of this application. All fields are required unless otherwise marked.
Permit Number
1.
– Provide your permit number.
Permit Number:
3. Site Contact
– Ecology may contact this person
2. Permittee Contact Information
regarding questions about the site restoration.
Organization Name – Provide the legal name of the
Site Contact First & Last Name:
business or company (Permittee):
Legal Responsible Party – Provide the first and last name
of the person who has the legal authority to represent the
Organization Name:
permittee and commit to the terms and conditions of the
permit:
E-mail:
Business Phone:
Business Phone:
E-mail (Optional):
Mailing Address:
Mailing Address:
City:
State:
Zip + 4:
City:
State:
Zip + 4:
Cell Phone (Optional):
Fax (Optional):
Cell Phone (Optional):
Fax (Optional):
4. Site Owner
5. Site Information
Site Owner First & Last Name:
Site Name:
Street Address:
Organization Name (Optional):
Mailing Address:
City:
Zip + 4:
City:
State:
Zip + 4:
Site’s Sand and Gravel General Permit Number
(if applicable):
Business Phone:
Cell Phone (Optional):
E-mail (Optional):
ECY 070-30 (Rev.01/18)
6. Site Restoration
Who was (or will be) responsible for site restoration? Answer the questions below, or provide the documentation, that
correspond to your answer.
We were (portable owner
Construction contractor
Site owner that is
Other (provide
/ operator).
(or site owner completing
different from the portable
explanation):
their own construction
owner / operator.
_________________
project).
Provide the date when you
Did the portable operate at
Attach documentation
Explain:
completed final
an active construction
demonstrating that you
restoration:
site?
are not responsible for
site restoration.
No
Yes
Describe what actions
were taken to restore the
site when the portable
Will site restoration be
operation was moved out
completed according to
(e.g. area seeded,
construction plans for the
concrete footings
site?
removed):
No
Attach documentation
Yes
demonstrating that you
are not responsible for
Provide estimated
site restoration.
timeline (date) for final
restoration:
Were you prohibited by law from accessing the site to complete site restoration?
No
Yes, attach documentation to this form demonstrating your inability to access the site.
7. Certification of Permittees
“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 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.”
.
Printed Name / Company (Permittee)
Title
.
Signature of Responsible Person*
Date
* Federal regulations require this application is signed by one of the following:
A. For a corporation: By a principal executive officer of at least the level of vice president.
B. For a partnership or sole proprietorship: By a general partner or the proprietor, respectively.
C. For a municipality, state, federal, or other public facility: By either a principal executive officer or ranking elected
official.
ECY 070-30 (Rev.01/18)
Mailing Address -
Mail your completed form to the appropriate Ecology Regional Office listed below, based on the
county in which the restored site is located:
Regional Office Address
Counties
Attn: WQ Sand & Gravel Permit Coordinator
Washington State Department of Ecology
Benton, Chelan, Douglas, Kittitas, Klickitat, Okanogan, or
Central Regional Office
Yakima Counties
1250 West Alder Street
Union Gap, WA 98903-0009
Attn: WQ Sand & Gravel Permit Manager
Adams, Asotin, Columbia, Ferry, Franklin, Garfield, Grant,
Washington State Department of Ecology
Lincoln, Pend Oreille, Spokane, Stevens, Walla Walla, or
Eastern Regional Office
Whitman Counties
4601 North Monroe Street Suite 202
Spokane, WA 99205-1295
Attn: WQ Sand & Gravel Permit Coordinator
Washington State Department of Ecology
Island, King, Kitsap, San Juan, Skagit, Snohomish, or
Northwest Regional Office
Whatcom Counties
3190 160th Avenue S.E.
Bellevue, WA 98008-5452
Attn: WQ Sand & Gravel Permit Coordinator
Washington State Department of Ecology
Clallam, Clark, Cowlitz, Grays Harbor, Lewis, Mason,
Southwest Regional Office
Pacific, Pierce, Skamania, or Wahkiakum Counties
300 Desmond Drive
PO Box 47775
Olympia, WA 98504-7775
Accommodation Requests:
To request ADA accommodation including materials in a format for the visually impaired, call Water Quality Reception at
Ecology, 360-407-6600. Persons with impaired hearing may call Washington Relay Service at 711. Persons with speech
disability may call TTY at 877-833-6341.
ECY 070-30 (Rev.01/18)
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