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For Agency Use Permit # Notice of Termination (NOT) of Coverage for Storm Water Discharges Associated with Industrial Activity Under an ANDES General Permit Submission of this Notice of Termination

Notice of this action may be made under Section I(A) or under Section II of this form. Section I(A) Disposal Permit- Permitted may not discharge storm water into or from any aquifer unless: (A) Appropriate permits or other approvals have been obtained and posted in accordance with Section II of this document; (B) Operator or owner pays annual charge for storm water discharge (See Section II of this document); © Operator and owner notify in writing of storm water discharge date (See Section II of this document); (D) Operator and owner sign application for Storm Water Discharge Permit in the appropriate place, provided the application can be obtained from the State Wastewater Authority; (E) Operator and owner pay annual charge for storm water discharge through an approved third party (See Section II of this document); (F) Operator and owner obtain permit from the State Wastewater Authority on or before January 1 following the date of the request for storm water discharge; and (G) Operator and owner provide all required information to the State Wastewater Authority, including any plans for the storage and treatment of storm water when it is discharged, when the permit ceases to be valid; (H) Operators have complied with the requirements of this document; and (I) Operators do not continue to discharge storm water in the same manner, and after the date of this notice, for the period identified in Section II(K) of this document. Section II (General) (A) Operators must comply with applicable storm water discharge permits listed in Sections I and I-B during the month for which permits are requested, except as provided in Section II(H). (B) Operators need not comply with any other storm water discharge permit. © Operators may not discharge storm water into or from any aquifer in any manner except as provided in Section II(A). (D) Operators must notify on the same calendar day as the storm water discharge date in accordance with Section II(C). (E) Operators must file monthly reports of their compliance with applicable storm water discharge permits during the month for which the permits are requested.

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