6100-22 Notice of Intent

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.
2040-0284

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 permit; agrees to
comply with all applicable terms and conditions of the permit; and understands that continued authorization under the permit 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 (PDMP) prior to NOI submittal. Refer to the
instructions at the end of this form to complete your NOI.

Approval to Use Paper NOI Form (Electronic Submission Waiver)
Has the EPA Regional Office granted you a waiver from electronic reporting*?

YES

NO

If yes, check which waiver you have been granted, the name of the EPA Regional Office staff person who granted the waiver, and the
date of approval:
Waiver granted:

The Decision-maker is physically located in a geographical area (i.e., ZIP code or census tract) that is identified as
under-served for broadband Internet access in the most recent report from the Federal Communications
Commission.
The Decision-maker has limitations regarding available computer access or computer capability.

Name of EPA staff person
who granted the waiver:
/

Date approval obtained:

/

*Note: You are required to obtain approval from the applicable EPA Regional Office prior to using this paper NOI form. If you
have not obtained a waiver, you must file this form electronically using the NPDES eNOI system at
https://www.epa.gov/npdes/pesticide-permitting.
A. Notice of Intent Status
1. Mark whether this is the first time you are requesting coverage under the 2016 PGP, or if this is a change of information for a discharge
already covered under the 2016 PGP. If this is a change of information, supply the NPDES permit tracking number for the discharge.
a.

Original NOI Submission

b.

NOI Change of Information:

(NPDES Permit Tracking Number)

Please note: When selecting A.1.b please fill out Section B (Operator Name and Mailing Address) and the fields of the NOI that need to be modified.

B. Operator Information
1. Operator Name:
2. 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:

3. Are you a large entity as defined in Appendix A of the permit? (check one):
Yes
No
Please note: If you answer “Yes” to question 3 you are required to develop a Pesticide Discharge Management Plan (PDMP) and submit an Annual
Report reflecting all pesticide uses for which you are requesting permit coverage under this NOI.

4. In which state are your pest management areas located? Please specify only one state per NOI:
5. Mailing Address:
a. Street:
b. City:
e. Telephone:

c. State:

–

–

Ext

f. Fax:

–

d. ZIP Code:

–

–

g. Contact Name:

h. E-mail:

EPA FORM 6100-22 (Revised October 24, 2016)

Page 1 of 7

C. Pest Management Areas: Complete Section C for each Pest Management Area for which coverage under EPA’s Pesticide
General Permit is desired. Copy this section for additional Pest Management Areas.
Pest Management Area #___ of ##___

1. Pest Management Area Name:__________________________________________________________________________________________________
Provide a map of the location of the Pest Management Area 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 occurring on Indian Country?

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 occurring on areas considered “federal
facilities” as defined by the permit?
Yes
No

4. Mailing address and contact information of the pesticide Applicator (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.

Mosquito and Other Flying Insect Pest Control

c.

Animal Pest Control

b.

Weed and Algae Pest Control

d.

Forest Canopy 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 a and b:

Yes

No

a. Name of Tier 3 water(s): _________________________________________________________________________________________________
b. 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 of the pesticide designated for use or is a degradate of such an active
ingredient. See Part 1.1.2.1 of the permit. 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.

EPA FORM 6100-22 (Revised October 24, 2016)

Page 2 of 7

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 additional Pest Management Areas.
Pest Management Area #___ of ##___
1. Identify the criterion for which you are eligible for permit coverage as it applies to 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 National Marine
Fisheries Service (NMFS) Listed Resources of Concern, as defined in Appendix A, of the PGP.

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 of the PGP, but consultation with NMFS under Section 7 of the Endangered Species
Act (ESA) has been concluded for pesticide application activities covered under the PGP. 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 of the PGP, 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 of the PGP, but only in response to a Declared Pest Emergency Situation.

e.

Pesticide application activities for which permit coverage is being requested in the NOI will discharge to one or more waters of the United States
containing NMFS Listed Resources of Concern, as defined in Appendix A of the PGP. Eligible discharges include those where the Decision-maker
includes in the NOI written correspondence from NMFS that pesticide application activities performed consistent with appropriate measures will
avoid or eliminate the likelihood of adverse effects to NMFS Listed Resources of Concern.

f.

Pesticide application activities for which permit coverage is being requested in the NOI will discharge to one or more waters of the United States
containing NMFS Listed Resources of Concern, as defined in Appendix A of the PGP. Eligible discharges include those from pesticide application
activities that are demonstrated by the Decision-maker as not likely to adversely affect NMFS Listed Resources of Concern or that the pest poses a
greater threat to the NMFS Listed Resources of Concern than does the discharge of the pesticide.

2. If you checked criterion d or criterion f above, provide the following information for all discharges to waters of the United States containing NMFS Listed
Resources of Concern identified within the pest management area for which permit coverage is being requested. For discharges pursuant to criterion d,
Declared Pest Emergency Situations, information for items a through g should also include any discharges that have already occurred prior to NOI
submission as well as the activities you performed in the 15 day period before submission of this NOI was required. In some cases, implementation of
pest management measures as specified in the permit involves a degree of “adaptive management” such that exact timing and quantities of applications
cannot be determined in advance for the duration of the permit. In such cases, the permittee must provide the required information to the extent feasible
and consistent with the implementation of the selected pest management measures.
a.

Describe the location of the pest management area in detail or provide a map of the location

b.

Pest(s) to be controlled:
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________

c.

Pesticide product(s) to be discharged and method of application: _________________________________________________________________

d.

Planned quantity and rate of discharge(s) for each method of application: __________________________________________________________

e.

Number of planned discharges: ____________

f.

Approximate date(s) of planned discharge(s): ________________________________________________________________________________

g.

Your rationale supporting your determination that you meet the criterion for which you are submitting this NOI, for example, the specific BMPs
applied, visual monitoring, equipment and/or site inspections, and other appropriate measures that will be undertaken to avoid or eliminate the
likelihood of adverse effects. For certifications pursuant to criterion d, indicate whether the discharge is likely to adversely affect NMFS Listed
Resources of Concern in response to a pest emergency and, if so, any feasible measures to avoid or eliminate such adverse effects; for example, it
is not sufficient to state that “integrated pest management procedures will be applied” without describing the specific measures to be taken (attach
additional pages as necessary):
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________

EPA FORM 6100-22 (Revised October 24, 2016)

Page 3 of 7

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.
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:

EPA FORM 6100-22 (Revised October 24, 2016)

Page 4 of 7

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 Operator, as described in Part 1.2.2 of the permit and meeting the eligibility
requirements identified in Part 1.1 of the permit and Table 1-1 below must submit a
complete and accurate NOI. As required in the permit, only certain Operators who are
also Decision-makers must submit NOIs.
Table 1-1. Decision-Makers Required to Submit NOIs
PGP Part/
Which Decision-Makers Must
For Which Pesticide
Pesticide Use
Submit NOIs?
Application Activities?
All four use
Any Decision-maker with an eligible Activities resulting in a
patterns
discharge to a Tier 3 water
discharge to a Tier 3 water
identified in
(Outstanding National Resource
Part 1.1.1
Water) consistent with Part 1.1.2.2
All four use
Any Decision-maker with an eligible Activities resulting in a
patterns
discharge to waters of the United
discharge to waters of the
identified in
States containing NMFS Listed
United States containing
Part 1.1.1
Resources of Concern, as defined in NMFS Listed Resources of
Appendix A
Concern, as defined in
Appendix A
1.1.1(a) Any Agency for which pest
All activities resulting in a
Mosquito and management for land resource
discharge for which the
Other Flying
stewardship is an integral part of the Federal or State agency is
Insect Pest
organization’s operations.
responsible for pest control
Control
Mosquito control districts, or similar All activities resulting in a
pest control districts
discharge for which the
Decision-maker is
responsible for pest control

1.1.1(b) Weed and
Algae Pest
Control

1.1.1(c) Animal Pest
Control

Local governments or other entities
who exceed the annual treatment
area threshold identified here

Adulticide treatment if more
than 6,400 acres during a
calendar year

Any Agency for which pest
management for land resource
stewardship is an integral part of the
organization’s operations.

All activities resulting in a
discharge for which the
Federal or State agency is
responsible for pest control

Irrigation and weed control districts,
or similar pest control districts

All activities resulting in a
discharge for which the
Decision-maker is
responsible for pest control

Local governments or other entities
who exceed the annual treatment
area threshold identified here

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

Any Agency for which pest
management for land resource
stewardship is an integral part of the
organization’s operations.

All activities resulting in a
discharge for which the
Federal or State agency is
responsible for pest control

Local governments or other entities
who exceed the annual treatment
area threshold identified here

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

1.1.1.(d) Any Agency for which pest
Forest Canopy management for land resource
Pest Control
stewardship is an integral part of the
organization’s operations.
Local governments or other entities
who exceed the annual treatment
area threshold identified here

All activities resulting in a
discharge for which the
Federal or State agency is
responsible for pest control
Treatment if more than 6,400
acres during a calendar year

If you have questions about whether you need to file an NOI or questions about
completing the form, see https://www.epa.gov/npdes/pesticide-permitting or contact
the NOI Center toll free at 866-352-7755.
One NOI can be submitted for multiple pest management areas in a state for which
you are seeking permit coverage; however, no more than one state can be included on
any single NOI form.
EPA FORM 6100-22 (Revised October 24, 2016)

When to File the NOI?
Do not file your NOI until you have obtained and thoroughly read a copy of the permit.
A copy of the permit is on EPA’s website (https://www.epa.gov/npdes/pesticidepermitting).The permit describes procedures to ensure your eligibility, prepare your
Pesticide Discharge Management 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 permit once you have obtained coverage so that you can comply with the
implementation requirements of the permit. Note: PDMP is not required for 1) any
application made in response to a Declared Pest Emergency Situation, as defined in
Appendix A of the permit; and 2) any Decision-maker who is required to submit an NOI
solely because their application results in a point source discharge to waters of the
United States containing NMFS Listed Resources of Concern, as defined in Appendix
A of the permit.
Approval to Use Paper NOI Form: Note that you are not authorized to use this paper
NOI form unless the EPA Regional Office has approved its use. Where you have
obtained approval to use this form, indicate the waiver that you have been granted, the
name of the EPA staff person who granted the waiver, and the date that approval was
provided.
For any discharges after October 31, 2016: All eligible discharges are authorized for
permit coverage through January 12, 2017 without submission of an NOI. For any
discharges after January 12, 2017, Decision-makers meeting the eligibility
requirements identified in the Part 1.1 of the permit and Table 1-1 must submit a
complete and accurate NOI according to Table 1-2 and Table 1-3 and consistent with
the requirements of Part 1.2 of the permit. Note: NOIs submitted under the 2011 PGP
are automatically terminated on October 31, 2016. Decision-makers who are required
to submit an NOI must submit a new NOI by January 12, 2017 to obtain coverage
under the 2016 PGP.
Table 1-2. NOI Submittal Deadlines and Discharge Authorization Dates for
Discharges from the Application of Pesticides 1
After January 12, 2017, any eligible discharge for which an NOI is required must
submit an NOI consistent with the earliest due date identified below. If EPA receives
an NOI on or before January 2, 2017 (or on or before December 12, 2016, for
discharges to waters of the United States containing NMFS Listed Resources of
Concern), uninterrupted coverage continues. NOI due dates for any discharges
occurring on or after January 12, 2017 are as follows:
NOI Submission
Discharge Authorization
Operator Type
Deadline
Date2
Any Decision-maker with any
At least 30 days before No earlier than 30 days
discharge to waters of the
any discharge to
after EPA posts on the
United States containing NMFS waters of the United
Internet a receipt of a
Listed Resources of Concern,
States containing
complete and accurate
except for those discharges in NMFS Listed
NOI.3, 5
response to a Declared Pest
Resources of Concern,
Emergency Situation, as
as defined in Appendix
defined in Appendix A.
A. 5
Any Decision-maker with a
discharge in response to a
Declared Pest Emergency
Situation for which that activity
triggers the NOI requirement
identified in Part 1.2.2, except
for any discharges to waters of
the United States containing
NMFS Listed Resources of
Concern.

No later than 30 days
after beginning
discharge.

Immediately upon
beginning to discharge for
activities conducted in
response to a Declared
Pest Emergency
Situation.

Any Decision-maker with any
discharge to waters of the
United States containing NMFS
Listed Resources of Concern, in
response to a Declared Pest
Emergency Situation, as
defined in Appendix A.

No later than 15 days
after beginning to
discharge in response
to a Declared Pest
Emergency Situation.

Immediately upon
beginning to discharge for
activities conducted in
response to a Declared
Pest Emergency Situation
for a period of at least 60
days. 4

Any Decision-maker who
exceeds any annual treatment
area threshold.

At least 10 days before
exceeding an annual
treatment area
threshold.

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

Page 5 of 7

Operator Type
Any Decision-maker otherwise
required to submit an NOI as
identified in Table 1-1

1
2

3

4

5

NOI Submission
Deadline
At least 10 days before
any discharge for
which an NOI is
required

Discharge Authorization
Date2
No earlier than 10 days
after EPA posts on the
Internet receipt of a
complete and accurate
NOI.

State, territory and tribal specific requirements in addition to the requirements in this
table are provided in Part 9 of the permit.
On the basis of a review of an NOI or other information, EPA may delay
authorization to discharge beyond any timeframe identified in Table 1-2, determine
that additional technology-based and/or water quality-based effluent limitations or
other conditions are necessary, or deny coverage under this permit and require
submission of an application for an individual NPDES permit, as detailed in Part 1.3
of the permit.
Within 30 days after EPA posts on the Internet receipt of a complete and accurate
NOI, for those areas with NMFS Listed Resources of Concern, as defined in
Appendix A of the permit, NMFS will provide EPA with a determination as to
whether it believes the eligibility criterion of “not likely to adversely affect listed
species or designated critical habitat” has been met, could be met with conditions
that NMFS identifies, or has not been met. EPA expects to rely on NMFS’
determination in deciding whether to withhold authorization. If NMFS does not
provide EPA with this information within 30 days of EPA posting on the Internet
receipt of a complete and accurate NOI, the discharges will be authorized 30 days
after EPA posts on the Internet receipt of a complete NOI.
In any Declared Pest Emergency Situation in areas with waters of the United States
containing NMFS Listed Resources of Concern, NMFS will have 30 days after
submission of an NOI to provide EPA with a determination as to whether the
eligibility criteria of “not likely to adversely affect listed species or designated critical
habitat” has been met, could be met with conditions that NMFS identifies, or has
not been met. EPA expects to rely on NMFS’ determination in deciding whether to
allow continued permit coverage and if additional conditions are necessary. If
NMFS does not provide EPA with a recommendation within 30 days of EPA posting
on the Internet receipt of a complete and accurate NOI, authorization for these
discharges will continue. If EPA identifies additional permit conditions, or includes
additional permit conditions recommended by NMFS, as necessary to qualify
discharges as eligible for coverage beyond 60 days under the PGP, those
conditions remain in effect for the life of the permit.
EPA may authorize certain discharges in less than 30 days, but no fewer than 10
days, for any discharges authorized under Criterion B, C, or E of Part 1.1.2.4 (for
which NMFS has already evaluated the effects of these discharges).
Table 1-3. NOI Change of Information Submittal Deadlines and Discharge
Authorization Dates
NOI Submission
Discharge Authorization
Operator Type
Deadline
Date
Any Decision-maker requiring
At least 10 days
No earlier than 10 days
permit coverage for a pest
before beginning to after EPA posts on the
management area not identified discharge in that
Internet the receipt of a
on a previously submitted NOI newly identified area complete and accurate NOI
for this permit, except for
unless discharges
unless discharges are in
discharges to any; (1) Tier 3
are in response to a response to a Declared
water, or (2) waters of the
Declared Pest
Pest Emergency Situation
United States containing NMFS Emergency Situation in which case coverage is
Listed Resources of Concern.
in which case not
available immediately upon
Except for such waters,
later than 30 days
beginning to discharge
changes other than
after beginning
from activities conducted in
identification of a new pest
discharge.
response to Declared Pest
management area or a new
Emergency Situation.
pesticide use pattern do not
require a revised NOI submittal.
Any Decision-maker discharging
to a Tier 3 water not identified
by name on a previously
submitted NOI for this permit,
except for Tier 3 waters
containing NMFS Listed
Resources of Concern

At least 10 days
before beginning to
discharge in that
newly identified area
unless discharges
are in response to a
Declared Pest
Emergency Situation
in which case not
later than 30 days
after beginning
discharge.

EPA FORM 6100-22 (Revised October 24, 2016)

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

Operator Type
Any Decision-maker with any
discharge to waters of the
United States containing NMFS
Listed Resources of Concern,
as defined in Appendix A, not
identified on a previously
submitted NOI for this permit.
This includes changes in any
treatment area, pesticide
product, method or rate of
application, or approximate
dates of applications.

NOI Submission
Deadline
At least 30 days
before beginning to
discharge in that
newly identified
treatment area
unless discharges
are in response to a
Declared Pest
Emergency Situation
in which case not
later than 15 days
after beginning
discharge.

Discharge Authorization
Date
No earlier than 30 days
after EPA posts on the
Internet receipt of a
complete and accurate NOI
unless discharges are in
response to a Declared
Pest Emergency Situation
in which case coverage is
available immediately upon
beginning to discharge
from activities conducted in
response to Declared Pest
Emergency Situation.

Where to File the NOI
The Decision-maker must prepare and submit the NOI using EPA’s electronic Notice
of Intent system (eNOI) available on EPA’s website
(https://www.epa.gov/npdes/pesticide-permitting) unless the Decision-maker is granted
a waiver from the requirement to use eNOI for submission of the NOI. See Part 8 of
the PGP for EPA Regional contacts. The Electronic Submission Waiver is at the top of
this form.
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 are granted a waiver from using eNOI; you must send the NOI form 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, 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.
 If you are required to develop a PDMP, that document does not need to be
submitted for review unless specifically requested by EPA. 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 System.
Section A. NOI Status
1. Indicate if this is the first time you are requesting coverage under the permit or if
this is a change of information.
a. Check this box if this is the first time you are requesting coverage under the permit
for these discharges. If this is the first time you are requesting coverage, refer to
Table 1-2 for NOI submittal deadlines and discharge authorization dates.
b. Check this box if this is a change of information for a discharge already covered
under the permit. 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 using EPA’s eNOI System
(https://www.epa.gov/npdes/pesticide-permitting). For additional details regarding a
change of information, see Table 1-3. Also fill out Section B of this form (Operator
Name and Mailing Address) and the associated fields of information that need to be
modified on the NOI.

Page 6 of 7

Section B. Operator Information
1. Provide the legal name of the person, firm, public organization or any other public
entity who is the Decision-maker for the pesticides applications described in this
notice. A Decision-maker is an Operator 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. Indicate the type of Operator: federal government, state government, local
government, mosquito control district (or similar), irrigation control district (or
similar), weed control district (or similar), or other. If other, provide brief description
of type of Operator in the space provided.
3. Indicate whether or not you are a “large entity” as defined in Appendix A of the
permit. Note that if you are a large entity, you are required to develop a Pesticide
Discharge Management Plan (PDMP) and submit future Annual Reports reflecting
all pesticide uses for which you are requesting permit coverage under this NOI.
4. Indicate which state your pest management areas are located. Specify only one
state per NOI. If there is more than one state, additional NOIs must be submitted.
5. Provide the Decision-maker’s mailing address, telephone number, fax number
(optional), name, and e-mail address. Correspondence will be sent to this address.
Section C. Pest Management Area: 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. Attach a map of the pest management area or describe the
location of the pest management area in the space provided. A mapping tool is
available at https://www.epa.gov/npdes/pesticide-permitting-PGP-eNOI.
2. Indicate whether pesticide application will occur on Indian Country, and if so,
provide the name of the reservation, if applicable.
3. Indicate whether pesticide application will occur on a Federal Facility, as defined in
Appendix A of the permit.
4. Enter the mailing address of the contact person for the pest management area. If
this address is the same as the Decision-maker’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.
5. Indicate the pesticide use patterns for the pest management area for which the NOI
is required. For additional information regarding pesticide use patterns, see Part
1.1.1 of the permit. Check all the use patterns that apply to the pest management
area.
6. 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 specific waterbodies, name those specific waterbodies in the space
provided. EPA’s Water Locator Tool can help you identify the closest receiving
water to your facility (http://www.epa.gov/waterdata/waters-tools).
7. 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 Tier 3 water(s) 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.
8. Verify that waters within the pest 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 Part 1.1.2.1 of the permit for more
information on discharges to Water Quality Impaired Waters.
Section D. Endangered Species Protection. Complete Section D for each Pest
Management Area for which coverage under EPA’s PGP is desired.

specific criteria for determining eligibility. To demonstrate eligibility, you must meet one
or more of the six criteria (a-f) for the entire term of coverage under the permit.
2. If you checked criterion d or criterion f, you are required to provide a description of
the location of the pest management area or a map of the location of the pest
management area, the pest(s) to be controlled, pesticide product(s) to be discharged
and method of application, planned quantity and rate of discharge(s) for each
application method, number of planned discharges, approximate date(s) of planned
discharge(s), and the rational supporting your determination that you meet the criterion
for which the Decision-maker is submitting this NOI and documentation demonstrating
the finding of “not likely to adversely affect.” If you certify under criteria f and do not
hear from EPA within 30 days, you may assume your discharge is authorized. For
certifications pursuant to criterion d, indicate whether the discharge is likely to
adversely affect NMFS Listed Resources of Concern and, if so, any feasible measures
to avoid or eliminate such adverse effects. If you are certifying under criterion d (which
allows you to discharge 15 days before you even submit your NOI), your NOI should
describe both the pest emergency activities you plan to do after you submit your NOI
as well as the activities you performed in that 15 day period before you had to submit
the NOI. See Part 1.1.2.4 of the permit for more information regarding Endangered
and Threatened Species and Critical Habitat Protection. If you certify under criterion d
and do not hear from EPA, you may assume that permit authorization continues
unless notified otherwise. EPA may authorize certain discharges in less than 30 days,
but no fewer than 10 days, for any discharges authorized under criterion b, c, or e (for
which NMFS has already evaluated the effects of these discharges). If you certify
under one of these criteria and do not hear from EPA within 30 days, you may assume
your discharge is authorized.
Section E. Certification
Enter the certifier’s printed name and title. Sign and date the form. For more
information about the certification statement and signature, see Appendix B of the
permit. (CAUTION: An unsigned or undated form will not be accepted.) Federal
statutes provide for severe penalties for submitting false information. 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 activity 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.

Identify the Pest Management Areas, corresponding to those in Part C.
1. Coverage under the permit is available only for discharges and discharge-related
activities, as defined in Appendix A of the permit, that are not likely to jeopardize the
continued existence of any species that are federally- listed as endangered or
threatened (“listed”) under the Endangered Species Act (ESA) and not likely to result
in the adverse modification or destruction of habitat that is federally-designated as
critical under the ESA (“critical habitat”) except as provided in criterion b, c, and for at
least 60 days, d, below. For a subset of listed species and critical habitat, identified as
NMFS Listed Resources of Concern and defined in Appendix A of the permit, there are
EPA FORM 6100-22 (Revised October 24, 2016)

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