4 Notice Of Termination (not)

UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
WASHINGTON, DC 20460
NOTICE OF TERMINATION (NOT) OF COVERAGE UNDER THE PESTICIDE GENERAL PERMIT
(PGP) FOR DISCHARGES FROM THE APPLICATION OF PESTICIDES

Form Approved
OMB No.
XXXX-XXXX

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 Notice of Termination form.
Briefly describe the reason why use of the electronic system causes undue burden or expense. _______________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
A. Permit Information

1. NPDES Permit Tracking Number:
2. Reason for termination (check one only):
a. You have ceased all discharges from the application of pesticides for which you obtained permit coverage and you do not expect
to discharge during the remainder of the permit term.
b. Permit coverage has been obtained under an NPDES individual permit or alternative NPDES general permit for all pesticide
discharges requiring NPDES permit coverage either because EPA required you to obtain such coverage or you petitioned EPA
requesting coverage under an alternative NPDES permit.
c. A new decision-maker has taken over responsibility for the pest control activities
covered under an existing NOI.

Date of transfer:

/

/

New Operator Name:
Street:
City:

State:
Telephone:

–

ZIP Code:
–

–

ext

E-mail:
B. Operator Information

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

–

3. Mailing Address:
Street:
City:

State:
Telephone:

–

ZIP Code:
–

–

ext

4.. Contact Name:
E-mail:

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C. Certification
I certify under penalty of law that I have met at least one of the reasons for terminating permit coverage listed in Section A above. I understand that by
submitting this Notice of Termination, I am no longer authorized to discharge pesticides to waters of the United States. This document and all
attachments were prepared under my direction and supervision in accordance with a system designed to ensure that qualified personnel properly
gather and evaluate the information submitted. 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 or imprisonment. Additionally, I understand
that the submittal of this Notice of Termination does not release a pesticide operator from liability for any violations of the Clean Water Act.

Printed Name:
Title:
E-Mail:
Signature/Responsible Official:

Date:

/

/

Date:

/

/

NOT Preparer (Complete if NOT was prepared by someone other than the certifier)

Preparer
Name :
Organization:
Phone:

–

–

Ext

E-Mail:

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Instructions for Completing the Notice of Termination (NOT) of Coverage under the Pesticide General Permit (PGP) for Discharges from the Application of Pesticides.
Who Must File an NOT Form with EPA?
Any decision-maker required to submit a Notice of Intent (NOI) is required to submit
a Notice of Termination (NOT) to end coverage under this permit. The requirement
to submit an NOT applies only to those decision-makers required to submit an NOI
to obtain permit coverage. Dischargers automatically covered under this permit as
identified in Part 1.2.3 are likewise automatically terminated upon permanent
cessation of discharge consistent with any of the criteria identified in Part 1.2.5.2.

2a. Select this box if you have ceased aquatic pesticide application or there is not,
or no longer will be a pesticide discharge.

If you have questions about whether you need to file an NOT or questions about
completing the form, see www.epa.gov/npdes/pesticides or contact the NOI Center
toll free at 866-352-7755.

Section B. Operator Information
1. Provide the full legal name of the person, firm, public organization, or other entity
that is the owner/operator of the pesticide application described in this application.

If you have specific questions about the Pesticide General Permit, send a detailed
e-mail to [email protected].

2. Provide the owner’s/operator’s mailing address. Correspondence will be sent to
this address.

When to File the NOT Form
Once all point source discharges associated with pesticide application have ceased,
the permittee must submit an NOT, as described in Part 1.2.5.1, within 30 days after
one or more of the conditions at 1.2.5.2 have been met.

3. Provide a contact person’s full legal name, telephone number, and e-mail
address. This person will be contacted regarding any NOT communication.

Where to File the NOT Form
Consistent with Part 1.2.5.1 the decision-maker must submit the NOT using EPA’s
electronic Notice of Intent System (eNOI) available on EPA’s website
(www.epa.gov/npdes/pesticides) unless eNOI is otherwise unavailable or the
decision-maker has obtained a waiver from the requirement to use eNOI for
submission of the NOT. The Electronic Submission Waiver is at the top of this form.
A decision-maker waived from the requirement to use eNOI for NOT submission
must certify to EPA on this form that use of eNOI will incur undue burden or
expense over the use of the paper NOT form and then provide a basis for that
determination.
Filing electronically is the fastest way to terminate permit coverage and help ensure
that your NOT is complete
If you do receive a waiver from using eNOI; you must send the NOT 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
Phone: 202-564-9545
If you have questions about whether you need to file an NOT or questions about
completing the form, see www.epa.gov/npdes/pesticides/eNOI or contact the
NOI Center at 1-866-352-7755.
If you file a paper NOT, submit the original with a signature in ink. Do not send
copies. Also, faxed copies will not be accepted.
Completing the NOI Form
To complete this form, type or print in uppercase letters in the appropriate areas
only. 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
can also use this paper form as a checklist for the information you will need when
filing an NOT electronically via EPA’s Pesticides eNOI system.

2b. Select this box if you have obtained an individual or alternative permit.
2c. Select this box if you have sold or transferred the responsibility of the pest
treatment and you are no longer the owner or operator. Provide the date of
transfer and the name and contact information of the new owner/operator.

Section C. Certification
Carefully read the certification statement. By completing and submitting the NOT,
the owner/operator certifies that every applicable general permit requirement will be
met. Sign and date the form. Provide the title and printed full legal name of the
certifier. (CAUTION: An unsigned or undated NOT form will prevent the termination
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, which 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 NOT was prepared by someone other than the certifier (for example, if the
NOT 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
NOT preparer.
Paperwork Reduction Act Notice
The public reporting and recordkeeping burden for this collection of information is
estimated to average .5 hours or 30 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 NOT form to that
address.

Section A. Permit Information
1. Enter the existing NPDES Pesticides General Permit Tracking Number assigned by
eNOI or the EPA’s Pesticides Processing Center. If you do not know the permit
tracking number, contact the Pesticides Processing Center at 1-866-352-7755.
2. Select the appropriate box to indicate why you are submitting an NOT to end
permit coverage. Select one of three options: because a new decision-maker has
taken over responsibility of pest control activities and you are no longer the
decision-maker, because you have ceased all discharges from the application of
pesticides for which you obtained permit coverage and you do not expect to
discharge during the remainder of the permit term, or because you have obtained
individual NPDES permit coverage or alternative NPDES permit coverage.

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