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; . . k, <br /> 3. Not Required to be Permitted. The facility is not required by federal regulations to be regulated by <br /> i industrial activities storm water NPDES permit. <br /> 4. Regulated by Another Permit. Discharge of storm water associated with industrial activity is <br /> specifically regulated by another general or individual NPDES permit. <br /> NPDES Permit No. Date coverage began I I <br /> 5. New Facility Operator. There is a new facility operator of the identified facility. <br /> Date facility was transferred to new facility operator <br /> Have you notified the new facility operator of the storm water NPDES Permit requirements? Yes <br /> No <br /> NEW FACILITY OPERATOR INFORMATION <br /> NAME _. CONTACT PERSON <br /> MAILING ADDRESS TITLE <br /> CITY STAID ZIP PHONE <br /> 6. Never Operated Facility I am not and have never been the operator of a facility required to be <br /> permitted. I have no responsibility for the facility's regulatory compliance. The correct facility <br /> operator who has regulatory responsibility for the facility is: <br /> r <br /> CORRECT FACILITY OPERATOR INFORMATION <br /> COWANY NAME -- - CONTACT PERSON <br /> MAILING ADDRESS TITLE <br /> CITY STATE ZIP PHONE _ <br /> Other. Other reason for non-applicability. (If necessary, attach letter or explanation.) <br /> I.,c,�y or� lo„ncd o.*\c4 50 1 51+� ".��uce. a�aea net pu z m'��- S�acm tx�o t�' V,,n a". <br /> VIII, CERTIFICATION <br /> I certify under penalty of law that I am not required to be permitted under the current Industrial Activities Storm <br /> Water General Permit No. 97-03-DWQ for any facility that I operate, I understand that discharging storm water <br /> associated with Industrial activity to waters of the United States is unlawful under the Clean Water Act where <br /> the discharge is not authorized by a NPDES permit. I am aware that there are significant penalties for <br /> submitting false information on this form, including the possibility of fine or imprisonment. I also understand <br /> that the submittal of this Notice of Non-Applicability does not release a facility operator from liability for any <br /> violations of the General Permit or the Clean Water Act. <br /> PRINTED NAME Co_ TITLE <br /> SIGNATURE DATE '416 / 2010 <br /> y <br />