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Central\'agcy ltegintul Watee Quality Control Board <br /> }443 Routi&Road Suite A <br /> San arncnto,CA 45927.1003 <br /> $tatc orCaliromia <br /> RcSionionxl VI'ater Quality Control Hoard <br /> NOTICE OF NON-APPLICABILITY <br /> Submission of this Notice of Non-Applicability constitutes notice that the fadlity operator identified on this form is not <br /> required to comply with the Industrial Activities No. 97-03-DWQ Storm Water General Permit <br /> 1. FACILITY INFORMATION <br /> A. Facility Operator Information B. Facility's SIC Code and Description <br /> NAME <br /> f <br /> LOCATION t6 r! CO D COL�44 <br /> A <br /> CITY ==� CA 7IP <br /> C. Facility Information (Only provide if different from facility operator information) <br /> FACILITY NAM1= � OCOf/OLI�S CONTACT P=RSON <br /> LOCATION /436,j TITLE d0t/NE-Q _ <br /> CITY LAG✓ „CA ZIP� 7_ PHONE -/ 3 ( r 5—/Sig <br /> 11. REGULATORY STATUS <br /> Have you fled a Notice of Intent for your facility(s)in the past? Yes No If No., go.to Sectlon Ill <br /> If yes,what was your WDII# When was a Notice of Termination filed? 1 t <br /> Has the Regional Board approved your Notice of Termination? Yes No <br /> lit. BASIS OF NON-APPLICABILITY 3 <br /> I am not required to comply with the above General Permit for the followinc reason: G <br /> 1, NOT REQUIRED TO BE PERMITTED. The faciiity(s)I operate has ro industrial activities which require compliance with <br /> a storm water permit. <br /> Type of Business (ClO�p(� <br /> 2- CLOSED FACILITY. The facility(s)I operate is closed and all clean-up, closure, and moving activities are complete. <br /> Date of closure 1 ! Did you move to new location? Yes No <br /> If yes, start date at new-location 1 l Did you file new NO]?Yes No <br /> NEW-FACILITY OPERATOR INFORMATION <br /> COMPANY NAME CONTACT PERSON <br /> MAILING ADDRESS TITLE <br /> CITY STATE ZIP <br />