3 Notice Of Intent (noi)

NPDES Pesticide General Permit for Point Source Discharges from the Application of Pesticides (New)

2397supp01 - PGP ICR NOI Form

Pesticide Applicators

OMB: 2040-0284

Document [pdf]
Download: pdf | pdf
UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
WASHINGTON, DC 20460
NOTICE OF INTENT (NOI) OF COVERAGE UNDER THE PESTICIDE
GENERAL PERMIT (PGP) FOR DISCHARGES FROM THE APPLICATION
OF PESTICIDES

Form Approved
OMB No.
XXXX-XXXX

Submission of this completed Notice of Intent (NOI) constitutes notice that the operator identified in Section B intends to be authorized to discharge pollutants to
waters of the United States within the pest management area identified in Section C under EPA’s Pesticide General Permit. Submission of this NOI constitutes
notice that the party identified in Section B of this form has read, understands, and meets the eligibility conditions of Part 1 of the PGP; agrees to comply with all
applicable terms and conditions of the PGP; and understands that continued authorization under the PGP is contingent on maintaining eligibility for coverage.
To be granted coverage, all information required on this form must be completed. Please read and make sure you comply with all permit requirements, including
the requirement for large entities to prepare a Pesticide Discharge Management Plan. Refer to the instructions at the end of this form to complete your NOI.

Electronic Submission Waiver
I hereby acknowledge my waiver request from the use of EPA’s electronic Notice of Intent system (eNOI) because my use of eNOI will
incur undue burden or expense over my use of this paper NOI form.
Briefly describe the reason why use of the electronic system causes undue burden or expense.
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
A. Notice of Intent Status
Mark whether this is the first time you are requesting coverage under this General Permit or if this is a change of information for a
discharge already covered under this General Permit. If this is a change of information, supply the NPDES permit tracking number for the
discharge.
1.

Original NOI Submission

2.

NOI Change of Information:

(NPDES Permit Tracking Number)

Please note: When Selecting # 2 please fill out Section B (Operator Name and Mailing Address) and the fields of the NOI that needs to be modified.

B. Operator Information
1. Operator Name:
2. IRS Employer Identification Number (EIN):

–

3. Operator Type (check one):
a.

Federal government

b.

State government

c.

Local government

d.

Mosquito control district (or similar)

e.

Irrigation control district (or similar)

f.

Weed control district (or similar)

g.

Other: If other, provide brief description of
type of operator:

4. Are you a large entity as defined in Appendix A of the PGP? (check one):
Yes

No

Please note: If you answer “Yes” to question 4 you are required to develop a Pesticide Discharge Monitoring Plan (PDMP) and submit an Annual Report
reflecting all pesticide uses for which you are requesting permit coverage under this NOI.
5. In which state are your pest management areas located? Please specify only one state per NOI:
6. Mailing Address:
a. Street:
b. City:

e. Telephone:

c. State:

–

–

ext

d. ZIP Code:

f. Fax:

–

–
–

g. Contact Name:

h. E-mail:

Page 1 of 6

C. Operator Information: Complete Section C for each Pest Management Area for which coverage under EPA’s Pesticide General
Permit is desired. Copy this section for non-electronic submissions.
Pest Management Area #___ of ##___
1. Pest Management Area Name: __________________________________________________________________________________________________
Provide a map of the location of the Pest Management Area for this use (attach map), or describe the location of the Pest Management Area in detail.
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
2. Are any of your activities for which you are requesting coverage under this NOI occur on Indian Country Lands?

Yes

No

_
_
_

If yes, identify the reservation or otherwise describe those areas:

3. Are any of your activities (in this pest management area) for which you are requesting coverage under this NOI occur on areas considered “federal facilities”
as defined by the PGP?
Yes
No
4. Mailing address and contact information (or check here

if same as provided in Section B):

a. Street:
b. City:

c. State:

e. Telephone:

–

–

ext

–

d. ZIP Code:
f. Fax:

–

–

g. Contact Name:
h. E-mail:
5. Pesticide Use Patterns to be included in this Pest Management Area (check all that apply):
a.
Control
b.

Mosquito and Other Flying Insect Pest

c.

Animal Pest Control

d.

Forest Canopy Pest Control

Weed and Algae Pest Control

6. Receiving Waters (check one):
a.

Coverage requested for all waters of the United States within the Pest Management Area identified above.

b.

Coverage requested specifically for the following waters of the United States within the Pest Management Area identified above.
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________

c.

Coverage requested for all waters of the United States within the Pest Management Area identified above except for:
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________

7. Tier 3 Waters
Is coverage requested for discharge to a Tier 3 water (Outstanding National Resource Water) of the United States?
If yes, answer 1) and 2):

Yes

No

1) Name of Tier 3 water(s): ________________________________________________________________________________________________
2) Provide rationale for determination that pesticide discharge is necessary to protect water quality, the environment, and/or public health and that
any such discharge will not degrade water quality or will degrade water quality only on a short-term or temporary basis: ____________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
8. Water Quality Impaired Waters
Operators are not eligible for coverage under this permit for any discharges from a pesticide application to Waters of the United States if the waters are
identified as impaired by a substance which is either an active ingredient the pesticide designated for use or is a degradate of such an active ingredient.
See Part 1.1.2.1 of the PGP.
Check one:
a.

Waters are NOT impaired by any substance which is either an active ingredient of a pesticide to be discharged or a degradate of such an active
ingredient

b.

Waters are on a current state list as being impaired by a substance which is either an active ingredient of a pesticide to be discharged or a
degradate of such an active ingredient; however, evidence is attached documenting that the waters are no longer impaired.

Page 2 of 6

D. Endangered Species Protection: Complete Section D for each Pest Management Area for which coverage under EPA’s Pesticide
General Permit is desired. Copy this section for non-electronic submissions.
Pest Management Area #___ of ##___
Federally Listed Threatened or Endangered Species (i.e., Species) and/or Federally Designated Critical Habitat
(i.e., Habitat) (check one):
A.

Pesticide application activities will not result in a point source discharge to one or more Waters of the United States containing NMFS Listed
Resources of Concern, as defined in Appendix A, for this permit.

B.

Pesticide application activities for which permit coverage is being requested will discharge to one or more Waters of the United States containing
NMFS Listed Resources of Concern, as defined in Appendix A, but consultation with NMFS under section 7 of the ESA has been concluded for
pesticide application activities covered under this permit. Consultations can be either formal or informal, and would have occurred only as a result of a
separate federal action. The consultation addressed the effects of pesticide discharges and discharge-related activities on federally-listed threatened
or endangered species and federally-designated critical habitat, and must have resulted in either:
i. A biological opinion from NMFS finding no jeopardy to federally-listed species and no destruction/adverse modification of federally-designated
critical habitat; or
ii. Written concurrence from NMFS with a finding that the pesticide discharges and discharge-related activities are not likely to adversely affect
federally-listed species or federally-designated critical habitat.

C.

Pesticide application activities for which permit coverage is being requested will discharge to one or more Waters of the United States containing
NMFS Listed Resources of Concern, as defined in Appendix A, but all “take” of these resources associated with such pesticide application activities
has been authorized through NMFS’ issuance of a permit under section 10 of the ESA, and such authorization addresses the effects of the pesticide
discharges and discharge-related activities on federally-listed species and federally-designated critical habitat. (The term “take” means to harass,
pursue, hunt, shoot, wound, kill, trap, capture, or collect, or to attempt to engage in any such conduct. See Section 3 of the Endangered Species Act,
16 U.S.C. § 1532 (19).)

D.

Pesticide application activities were, or will be, discharged to one or more Waters of the United States containing NMFS Listed Resources of
Concern, as defined in Appendix A, but only in response to a declared pest emergency situation.

E.

Pesticide application activities for which permit coverage is being requested will discharge to one or more Waters of the United States containing
NMFS Listed Resources of Concern, as defined in Appendix A. Eligible discharges include those from pesticide application activities performed
consistent with appropriate measures to avoid or eliminate the likelihood of adverse effects as provided in writing from NMFS, and the Operator must
provide EPA with the required relevant supporting information from NMFS.

F.

Pesticide application activities for which permit coverage is being requested will discharge to one or more Waters of the United States containing
NMFS Listed Resources of Concern, as defined in Appendix A. Eligible discharges include those from pesticide application activities that are
demonstrated not likely to adversely affect federally-listed species or their designated critical habitat.
If you checked item F. above, list all NMFS Listed Resources of Concern identified within the area for which permit coverage is being requested:
1.

Pest(s) to be controlled: ________________________________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________

2.

Pesticide product(s) to be discharged: _____________________________________________________________________________

3.

Planned quantity and rate of discharge(s) __________________________________________________________________________

4.

Number of planned discharges: ____________

5.

Approximate date(s) of planned discharge(s) (in MM/DD/YYYY format):
_______________________________________________________________________

6.

Your rationale supporting your determination that you meet Criterion F, including appropriate measures to be undertaken to avoid or eliminate
the likelihood of adverse effects. (Attach additional pages as necessary.) ___________________________________________________

_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________

Page 3 of 6

E. Certification
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. On the basis of my inquiry of the
person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is,
to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fine and imprisonment for knowing violations. I further certify that the applicant has sufficient title,
right, or interest in the property where the proposed activity occurs.
Printed Name:
Title:
E-Mail:
Signature/Responsible Official:

Date:

/

/

Date:

/

/

NOI Preparer (Complete if NOI was prepared by someone other than the certifier)
Preparer Name:
Organization:
Phone:

–

–

Ext

E-Mail:

Page 4 of 6

Instructions for Completing the Notice of Intent (NOI) for Coverage Under the Pesticide General Permit (PGP) for Discharges from the Application of Pesticides
Who Must File a NOI with EPA?
Any owner/operator who is also a decision-maker, as described in the PGP Part 1.2.2
and meeting the eligibility requirements identified in the PGP Part 1.1 and Table 1
must submit a complete and accurate NOI.
Table 1. Decision-Makers Required to Submit NOIs
PGP Part/
Pesticide Use
All four use
patterns
identified in Part
1.1.1

Any decision-maker with an eligible
discharge to a Tier 3 water
(Outstanding National Resource
Water) consistent with Part 1.1.2.2

All

1.1.1(a) Mosquito and
Other Flying Insect
Pest Control

Federal and state agencies with a
responsibility to control mosquitoes
for public health, nuisance control,
and animal welfare

All

Mosquito control districts, or similar
pest control districts

All

Other entities that exceed the
annual treatment area threshold
identified here

Decision to treat with
adulticide during a
calendar year more than
6,400 acres

Federal and state agencies with a
responsibility to control weeds and
algae

All

1.1.1(b) Weed and Algae
Pest Control

Which Decision-Makers Must
Submit NOIs?

For Which Pesticide
Application Activities?

1.1.1.(d) Forest Canopy
Pest Control

Decision makers meeting the eligibility requirements identified in the PGP Part 1.1 and
Table 1 must submit a complete and accurate NOI according to Tables 2, 3, and 4 and
consistent with the requirements of the PGP Part 1.2.
Table 2. Original NOI Submittal Deadlines and Discharge Authorization Dates
Operator Type

Irrigation and weed control districts, All
or similar pest control districts

1.1.1(c) Animal Pest
Control

When to File the NOI Form
Do not file your NOI until you have obtained and thoroughly read a copy of the
Pesticides General Permit (PGP). A copy of the PGP is on EPA’s website
(www.epa.gov/npdes/pesticides/pgp). The PGP describes procedures to ensure your
eligibility, prepare your Pesticide Discharge Monitoring Plan (PDMP), and complete the
NOI form questions—all of which must be done before you sign the NOI certification
statement attesting to the accuracy and completeness of your NOI. You will also need
a copy of the PGP once you have obtained coverage so that you can comply with the
implementation requirements of the permit.

Other entities that exceed the
annual treatment area threshold
identified here

Decision to treat during a
calendar year more than
either:
20 linear miles
OR
80 acres of water (i.e.,
surface area)

Federal and state agencies with a
responsibility to control animals for
public health, nuisance, or
resource management

All

Other entities that exceed the
annual treatment area threshold
identified here

Decision to treat during a
calendar year more than
either:
20 linear miles
OR
80 acres of water
(i.e., surface area)

Federal and state agencies with a
responsibility to control forest
canopy pests

All

Other entities that exceed the
annual treatment area threshold
identified here

Decision to treat during a
calendar year more than
6,400 acres

NOI Submission Deadline

Discharge Authorization
Date

Any Operator not
required to submit an
NOI.

Not applicable.

Immediately upon beginning to
discharge.

Decision-makers
whose discharges
begin before October
9, 2011, and that will
exceed the criteria in
Part 1.2.2 requiring
submission of an NOI.

Due between October 9,
2011, and January 9, 2012.

Immediately upon beginning to
discharge. Authorization
granted until January 9, 2012.
If EPA receives an NOI on or
before January 9, 2012,
uninterrupted coverage
continues.

Decision-makers
whose discharges
begin after October 9,
2011 and that meet the
criteria in Part 1.2.2
requiring submission of
an NOI.

Due at least 10 days before
exceeding an annual
treatment area threshold.

Immediately upon beginning to
discharge, until the discharge
exceeds an annual treatment
area threshold. If a decisionmaker submits an NOI after
January 9, 2012, they are
reauthorized no earlier than 10
days after EPA posts on the
Internet the receipt of a
complete and accurate NOI.

Table 3. Emergency Discharges and Discharges to Tier 3 Waters

If you are unsure whether you need an NPDES Pesticides Permit, contact your EPA or
state NPDES pesticides permit program. Contacts are listed at
www.epa.gov/npdes/pesticidecontacts.
One NOI must be submitted for pest management areas in each state for which you
are seeking permit coverage.

Operator Type

NOI Submission Deadline

October 31, 2011, or
Discharge Authorization
Date, whichever comes later

All decision-makers
discharging to a Tier 3
water.

At least 10 days before
beginning discharge unless
discharges are in response to
a declared pest emergency,
in which case not later than
30 days after beginning
discharge.

No earlier than 10 days after
EPA posts on the Internet a
receipt of a complete and
accurate NOI unless discharges
are in response to a declared
pest emergency in which case
coverage is available
immediately upon beginning to
discharge from activities
conducted in response to
declared pest emergency.

Decision-maker
discharging in
response to a declared
pest emergency
situation as defined in
Appendix A for which
that activity triggers the
NOI requirement
identified in Part 1.2.2.

No later than 30 days after
beginning discharge but no
earlier than January 9, 2012.

Immediately upon beginning to
discharge for activities
conducted in response to
declared pest emergency
situation.

Table 4. NOI Change of Information Submittal Deadlines and Discharge
Authorization Dates
Operator Type

NOI Submission
Deadline

Discharge Authorization
Date
Page 5 of 6

Any decision-makers
discharging to a Tier 3
water, for Tier 3 waters
not specifically identified
by name on their most
recently submitted NOI.

At least 10 days before
beginning to discharge in
that newly identified
treatment area unless
discharges are in
response to a declared
pest emergency in which
case not later than 30
days after beginning
discharge.

No earlier than 10 days after
EPA posts on the Internet
receipt of a complete and
accurate NOI unless
discharges are in response to
a declared pest emergency in
which case coverage is
available immediately upon
beginning to discharge from
activities conducted in
response to declared pest
emergency.

Section A. NOI Status
1. Check this box if this is the first time you are requesting coverage under the PGP or
if this is a change of information for a discharge already covered under the PGP. If
this is a change of information, supply the NPDES permit tracking number that you
received in your confirmation letter or e-mail from EPA’s Pesticide Notice
Processing Center. You can find the tracking number assigned to your previous
NOI on EPA’s NOI Search website (www.epa.gov/npdes/noisearch). For additional
details regarding a change of information, see Table 4. If this is the first time you
are requesting coverage, refer to Table 2 for NOI submittal deadlines and discharge
authorization dates.
2. Enter the permit number under which you are requesting coverage. Appendix C of
the PGP identifies permit numbers in the states for each EPA Region.

Any decision-makers
requiring permit
coverage for a treatment
area not within the pest
management area
identified on a
previously submitted
NOI.

At least 10 days before
beginning to discharge in
that newly identified
area.

No earlier than 10 days after
EPA posts on the Internet the
receipt of a complete and
accurate NOI.

Section B. Operator Information
1. Provide the legal name of the person, firm, public organization or any other public
entity that operates or who is the decision-maker for the pesticides applications
described in this application. An operator of a facility is the decision-maker who has
control over the decision to perform pesticide applications including the ability to
modify those decisions that result in a discharge to Waters of the United States.
2. Provide the Employer Identification Number (EIN from the Internal Revenue Service
IIRS)), commonly referred to as your tax payer ID number. If the operator does not
have an EIN, enter “N/A” in the space provided.
3. Indicate the type of operator: federal government, state government, local
government, mosquito control district (or similar), irrigation control or other, weed
control district (or similar), or other. If other, provide brief description of type of
operator in the space provided.
4. Indicate whether or not you are a “large entity” as defined in Appendix A of the
PGP.
5. Provide the operator’s mailing address, telephone number, fax number (optional),
name, and e-mail address. Correspondence will be sent to this address.

Where to File the NOI Form
The Decision-maker must prepare and submit the NOI using EPA’s electronic Notice
of Intent system (eNOI) available on EPA’s website
(www.epa.gov/npdes/pesticides/eNOI) unless eNOI is otherwise unavailable or the
decision-maker has obtained a waiver from the requirement to use eNOI for
submission of the NOI. The Electronic Submission Waiver is at the top of this form.
Decision-makers waived from the requirement to use eNOI for NOI submission must
certify to EPA on this form that use of eNOI will incur undue burden or expense over
the use of the paper NOI form and then provide a basis for that determination.
EPA will immediately post on the pesticides eNOI website all NOIs received. Late
NOIs will be accepted, but authorization to discharge will not be retroactive.
If you do receive a waiver from using eNOI; you must send the NOI to one of the
addresses listed below.
Via United States Mail:
United States Environmental Protection Agency
Office of Water, Water Permits Division
Mail Code 4203M, ATTN: NPDES Pesticides
1200 Pennsylvania Avenue, NW
Washington, DC 20460
Via overnight/express delivery:
United States Environmental Protection Agency
Office of Water, Water Permits Division
EPA East Building - Room 7420, ATTN: NPDES Pesticides
1201 Constitution Avenue, NW
Washington, DC 20004
If you have questions, contact EPA’s Pesticides Notice Processing Center toll free at
866-352-7755.
If you file a paper NOI, submit the original with a signature in ink. Do not send
copies. Also, faxed copies will not be accepted.
Your PDMP does not need to be submitted for review unless specifically
requested by EPA or as otherwise required in the PGP. You must keep a copy
of your PDMP on-site or otherwise make it available to facility personnel
responsible for implementing provisions of the permit.
Completing the NOI Form
To complete this form, type or print in uppercase letters in the appropriate areas only.
Please make sure you complete all questions. Make sure you make a photocopy for
your records before you send the completed original form to the address above. You
may also use this paper form as a checklist for the information you will need when
filing an NOI electronically via EPA’s Pesticides eNOI.

Section C. Operator Information for each Pest Management Area for which
coverage under EPA’s Pesticide General Permit is desired.
1. Indicate whether you are submitting an NOI for multiple pest management areas. A
pest management area is the area of land, including any water, for which you have
responsibility and are authorized to conduct pest management activities as covered
by this permit (e.g., if you are a mosquito control district, your pest management
area is the total area of the district). You must complete a Section C for each pest
management area. If you are submitting an NOI for only one area, enter “1” of “1.” If
you are submitting NOIs for multiple pest management areas, enter the number for
the NOI for which you are requesting coverage followed by the total number of pest
management areas for which you are requesting coverage. Enter the name of the
pest management area. Provide both a map of the pest management and a
description of the pest management area in the space provided.
2. Enter the mailing address for the pest management area. If this address is the
same as the operator’s mailing address, indicate that by checking the box. If it is a
different address, enter the mailing address, telephone number, fax number
(optional), contact name, and e-mail address.
3. Indicate whether the pesticide application will occur on Indian County Lands, and if
so, provide the name of the reservation, if applicable. If the pest management area
is not part of a reservation, “Not Applicable.”
4. Indicate the pesticide use patterns for the pest management area for which the NOI
is required. For additional information regarding pesticide use patterns, see PGP
Part 1.1.1. Check all the use patterns that apply to the pest management area.
5. Indicate if permit coverage is being requested for all waters of the United States
within the pest management area or if permit coverage is being requested to
specific waters of the United States within the pest management area. If specific
waters are being requested, write the names of the waterbodies. If permit coverage
is being requested for all waters of the United States within the pest management
area except for a few waterbodies, name those waterbodies in the space provided.
EPA’s Water Locator Tool can help you identify the closest receiving water to your
facility (http://cfpub.epa.gov/npdes/stormwater/tmdltool.cfm).
6. Indicate if permit coverage is being requested to discharge to a Tier 3 (Outstanding
National Resource Water) water of the United States. If yes, write the name(s) of
the impaired waterbodies in the space provided. Describe and demonstrate why it
is necessary to apply the pesticide discharge to protect the water quality,
environment, and/or public health and that any such discharge will not degrade
water quality or will degrade water quality only on a short-term or temporary basis.
7. Verify that waters within the proposed management area are either not impaired by
substances which are either active ingredients in the pesticide planned for use or
degradates of such active ingredients, OR that evidence shows that the target
waters in question are no longer impaired (see attachment).

Page 6 of 6

Section D. Endangered Species Protection for Federally Listed Threatened or
Endangered Species (i.e., Species) and/or Federally Designated Critical Habitat
(i.e., Habitat). Complete Section D for each Pest Management Area for which
coverage under EPA’s PGP is desired.
Identify the Pest Management Areas, corresponding to those in Part C.
a. Indicate if pesticide application activities within the pest management area will
not overlap with the distribution map locations of any Species or Habitat.
b. Indicate if pesticide application activities within the pest management area will
overlap with the distribution of any Species or Habitat, but you have consulted
with the U.S. Fish and Wildlife Service (FWS) and/or the National Marine
Fisheries Service (NMFS) under Endangered Species Act (ESA) section 7
already, or already have an ESA section 10 permit issued to you by FWS and/or
NMFS for all those activities for which you are requesting coverage under this
permit.
c. Indicate if pesticide application activities within the pest management area will
overlap with the distribution of any Species or Habitat. If you checked this item,
list all Species or Habitat identified within the area for which permit coverage is
being requested.
Section E. Certification
Enter the certifier’s printed name, title, and e-mail address. Sign and date the form. For
more information about the certification statement and signature, see Appendix B of
the PGP. (CAUTION: An unsigned or undated NOI form will prevent the granting of
permit coverage.) Federal statutes provide for severe penalties for submitting false
information on this application form. Federal regulations require this application to be
signed as follows:
For a corporation: by a responsible corporate officer, means:
(i) president, secretary, treasurer, or vice-president of the corporation in charge of a
principal business function, or any other person who performs similar policy or
decision-making functions for the corporation, or
(ii) the manager of one or more manufacturing, production, or operating facilities,
provided the manager is authorized to make management decisions that govern the
operation of the regulated facility including having the explicit or implicit duty of
making major capital investment recommendations, and initiating and directing
other comprehensive measures to assure long-term environmental compliance with
environmental laws and regulations; the manager can ensure that the necessary
systems are established or actions taken to gather complete and accurate
information for permit application requirements; and where authority to sign
documents has been assigned or delegated to the manager in accordance with
corporate procedures;
For a partnership or sole proprietorship: by a general partner or the proprietor; or
For a municipal, state, federal, or other public facility: by either a principal executive or
ranking elected official.
If the NOI was prepared by someone other than the certifier (for example, if the NOI
was prepared by the PDMP contact or a consultant for the certifier’s signature), include
the name, organization, phone number and e-mail address of the NOI preparer.
Paperwork Reduction Act Notice
The public reporting and recordkeeping burden for this collection of information is
estimated to average 2.5 hours or 150 minutes per response.
Send comments on the Agency's need for this information, the accuracy of the
provided burden estimates, and any suggested methods for minimizing respondent
burden, including through the use of automated collection techniques to the Director,
Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200
Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in
any correspondence. Do not send the completed NOI form to that address.

Page 7 of 6


File Typeapplication/pdf
File TitleThis Form Replaces Form 3510-9 (8-98)Refer to the Following Pages for Instructions
AuthorGarrett Budd
File Modified2011-09-22
File Created2011-09-22

© 2024 OMB.report | Privacy Policy