Notice Of Termination (Not) For Construction Activity Discharges To Waters Of The United States
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1NOTICE OF TERMINATION (NOT)
for Construction Activity Discharges to Waters of the United States
Submission of this NOT constitutes notice that the party identified on this form is terminating coverage under the AZPDES Stormwater
Construction General Permit. Authorization for construction activity discharges to waters of the United States terminates at midnight on
the day the NOT is received by ADEQ. To terminate your project, mail or deliver a complete and accurate, ink-signed NOT to:
Arizona Department of Environmental Quality
Surface Water Section — Stormwater & General Permits Unit
1110 West Washington, 5415A-1; Phoenix, Arizona 85007
I. PERMITTEE INFORMATION
AZPDES Stormwater Construction Authorization Number: AZCON – ________________________________________
Name of Operator on Notice of Intent (NOI): ____________________________________________________________
Operator Business: ___________________________________ Address: ___________________________________
City: _____________________________ State: _____
Zip: __________
Phone: _________________________
II. CONSTRUCTION SITE INFORMATION
Project/Site Name: _______________________________________________________________________________
Site address or physical location: ____________________________________________________________________
_______________________________________________________________________________________________
City: _____________________________ State: _____
Zip: ___________ Phone: _________________________
III. REASON FOR TERMINATING COVERAGE: (Check as applicable)
_____
Final stabilization has been achieved on all portions of the site for which the operator is responsible.
_____
Another operator has assumed control over all areas of the site that have not been finally stabilized.
Provide new operator’s NOI AZCON Number(s): ______________________________________________
_____
For residential construction only, temporary stabilization has been completed and the residence has been
transferred to the homeowner.
_____
The operator has obtained coverage under another NOI authorization certificate or under an alternative
AZPDES permit. To qualify for this condition, you must provide the new AZCON number or AZPDES permit
number: New AZCON or AZPDES Number(s): _______________________________________________
_____
Construction activity was never initiated and plans have been abandoned or postponed.
_____
The operator qualifies for alternative stabilization pursuant to Part 3.1.2.3 of the CGP and the supporting
documentation is included with this NOT submission, including a copy of the most recent Stormwater
Pollution Prevention Plan and $1,000.00 review fee (see permit for additional documentation requirements).
IV. CERTIFICATION BY AUTHORIZED SIGNATORY
“I certify under penalty of law that all stormwater discharges associated with construction activity from the identified facility that
are authorized by a general permit have been eliminated or that I am no longer the operator of the facility or construction site. I
understand that by submitting this Notice of Termination, I am no longer authorized to discharge stormwater associated with
construction activity under this general permit, and that discharging pollutants in stormwater associated with construction activity
to waters of the United States is unlawful under the Clean Water Act where the discharge is not authorized by an AZPDES
permit. I also understand that the submittal of this Notice of Termination does not release an operator from liability for any
violations of this permit or the Clean Water Act.”
Printed Name: _______________________________________________ Title: __________________________________
Signature: _________________________________________________ Date: _________________________________
Address (if different from above): _______________________________________________________________________
City: ______________________________ State: _____
Zip: ____________ Phone: _________________________
June 2016
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