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X 3. NO STORM WATER DISCHARGE. None of my facility's storm water discharges directly or indirectly to waters of the United States(such as a river, lake,stream, ocean, municipal storm drain, etc.)because: X a. All storm water is retained on site(such as in an evaporation or percolation pond). b. All storm water is discharged to a municipal sanitary sewer system. C. All storm water is discharged to offshe(such as in evaporation or percolation ponds). 4. REGULATED BY ANOTHER PERMIT. My facili'ys storm water discharge is regulated by a separate NPDES Permit, NPDES Permit No. Date coverage began / / 5. NEW FACILITY OPERATOR. There is a new fa-ility operator of my facility(s). Date facility(s)was transferred to new facility operator _/_/ Have you notified the new facility operator of the storm water NPDES Permit requirements? Yes No NEW FACILITY OPERATOR INFORMATION COMPANY NAME CONTACT PERSON MAILING ADDRESS TITLE CiTY STATE ZIP 6. NEVER OPERATED FACILITY_ i am not and have never been the operator of a facility required to be permitted. I have no responsibility for the facility's regulatory compliance. The correct facility operator who has regulatory responsibility for the facility is: CORRECT FACILITY OPERATOR INFORMATION COMPANY NAME CONTACT PERSON MAILING ADDRESS TITLE CITY STATE ZIP 7. OTHER. Other reason for non-applicability. (If,necessary,attach letter or explanation.) M CERTIFICATION I certify under periaity of law that I am not required to be permitted under the Industrial Activities Storm Water General Permit No.97-03-DWO for any facility that I operate. L undystand that discharging storm water associated with industrial activity to waters of the United States is unlawful under the Clean Water Act where the discharge,is not authorized by a NPDES permit I am aware that there are significant penat5es_for submitting false Information on this form,including the possibility of fine or imprisonment. i also understand that the submittal of this Notice of Non-Applicability does not release a facility operator from liability for any violations of the General Permit or the Clean Wafer Act PRINTED NAME H Ino TiTLE President LSIGNATURE DATE z ! / 1