3510-7 Notice of Termination (NOT) Form

2021 MSGP Appendix H – Notice of Termination (NOT) Form

Appendix H - Notice of Termination (NOT) Form

Part 7.2 requires you to use the NPDES eReporting Tool, or “NeT”, to prepare and submit your Notice of Termination (NOT) form. However, if you are given a waiver by the EPA Regional Office to use a paper NOT form, and you elect to use it, you must complete and submit the following form.

NPDES FORM 3510-7

UNITED STATES ENVIRONMENTAL PROTECTION AGENCY WASHINGTON, DC 20460

NOTICE OF TERMINATION (NOT) FOR STORMWATER DISCHARGES ASSOCIATED WITH INDUSTRIAL ACTIVITY UNDER THE NPDES MULTI-SECTOR GENERAL PERMIT

OMB No. 2040-0300

Exp. Date: MM/DD/YYYY

Submission of this Notice of Termination constitutes notice that the operator identified in Section C of this form is no longer authorized to discharge pursuant to the NPDES Multi-Sector General Permit (MSGP) from the facility identified in Section D of this form. All necessary information must be included on this form. Refer to the instructions at the end of this form.

1. Approval to use Paper NOT Form

   1. Have you been granted a waiver from electronic reporting from the Regional Office*? 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 owner/operator’s headquarters is physically located in a geographic 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 owner/operator has issues regarding available computer access or computer capability.

Name of EPA staff person that granted the waiver:

Date approval obtained: / /

* Note: You are required to obtain approval from the applicable Regional Office prior to using this paper NOT form. If you have not obtained a waiver, you must file this form electronically using the NPDES eReporting Tool (NeT) at https://www.epa.gov/npdes/stormwater-discharges-industrial-activities

2. Permit Information

1. NPDES ID:

2. Reason for Termination (check one only):

A new owner or operator has taken over responsibility for the facility.

You have ceased operations at the facility, there are not or no longer will be discharges of stormwater associated with industrial activity from the facility, and you have already implemented necessary sediment and erosion controls as required by Part 2.1.2.5.

You are a Sector G, H, or J facility and you have met the applicable termination requirements.

You obtained coverage under an individual or alternative general permit for all discharges required to be covered by an NPDES permit.

3. Facility Operator Information

1. Operator Name:

2. Mailing Address: Street:

^{City: State: ZIP Code:} -

3. Phone: ^{- -} Ext.

4. E-mail:

4. Facility Information

1. Facility Name:

2. Facility Address: Street:

City: State: ZIP Code: -

County or similar government subdivision:

E. Certification Information
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 gathered and evaluated the information submitted. Based on 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.
First Name, Middle Initial, Last Name:
Professional Title:
Signature:					Date:				/
E-mail:

Instructions for Completing EPA Form 3510-7 Notice of Termination for Stormwater Discharges Associated with Industrial Activity Under the NPDES Multi-Sector General Permit NPDES Form Date (01/21) Expiration Date (MM/YY) This Form Replaces Form 3510-7 (06/15) Form OMB No. 2040-0300

Who May File Notice of Termination (NOT) Form Permittees currently covered by EPA’s NPDES Stormwater Multi- Sector General Permit (MSGP or permit) must submit a Notice of Termination (NOT) within 30 days after one or more of the following conditions have been met: A new owner or operator has assumed responsibility for the facility; You have ceased operations at the facility and there are not or no longer will be discharges of stormwater associated with industrial activity from the facility and you have already implemented necessary sediment and erosion controls per Part 2.1.2.5; You are a Sector G, H, or J facility and you have met the applicable termination requirements; or You obtained coverage under an individual or alternative general permit for all discharges required to be covered by an NPDES permit. See the MSGP Part 1.4.2 for more information. Completing the Form To complete this form, type or print, using uppercase letters, in the appropriate areas only. Please place each character between the marks. Abbreviate if necessary to stay within the number of characters allowed for each item. Use only one space for breaks between words, but not for punctuation marks unless they are needed to clarify your response. Please submit original document with signature in ink - do not send a photocopied signature. Section A. Approval to Use Paper NOT Form You must indicate whether you have been granted a waiver from electronic reporting from the EPA Regional Office. Note that you are not authorized to use this paper NOT 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 Regional Office staff person who granted the waiver, and the date that approval was provided. See https://www.epa.gov/npdes/contact-us-stormwater for a list of EPA Regional Office contacts. Section B. Permit Information Enter the existing NPDES ID (i.e., NOI tracking number) assigned to your permit authorization. Indicate your reason for submitting this NOT by checking the appropriate box. Check only one box (see MSGP Part 1.4.2 for more information). Section C. Facility Operator Information Provide the legal name of the person, firm, public organization, or any other entity that operates the facility described in this NOT. An operator of a facility is the legal entity that controls the operation of the facility. Refer to Appendix A of the permit for the definition of “operator”. Provide the operator’s mailing address, phone number, and e-mail.

Section D. Facility Information Enter the official or legal name and complete street address, including city, state, ZIP code, and county or similar government subdivision of the facility. If the facility lacks a street address, indicate the general location of the facility (e.g., Intersection of State Highways 61 and 34). Complete facility information must be provided for termination of permit coverage to be valid. Section E. Certification Information All NOTs must be signed as follows: For a corporation: By a responsible corporate officer. For the purpose of this Section, a responsible corporate officer means: (i)a 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 which 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, respectively; or For a municipality, state, federal, or other public agency: By either a principal executive officer or ranking elected official. For purposes of this Part, a principal executive officer of a federal agency includes (i) the chief executive officer of the agency, or (ii) a senior executive officer having responsibility for the overall operations of a principal geographic unit of the agency (e.g., Regional Administrator of EPA). Include the name and title of the person signing the form and the date of signing. Include the name, title, and e-mail address of the person signing the form and the date of signing. An unsigned or undated NOT form will not be considered valid termination of permit coverage. Paperwork Reduction Act Notice This collection of information is approved by OMB under the Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No. 2040-0300). Responses to this collection of information are mandatory (40 CFR 122.26). An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The public reporting and recordkeeping burden for this collection of information is estimated to be 0.5 hours 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 to the Regulatory Support Division Director, U.S. Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed form to this address.

Instructions for Completing EPA Form 3510-7 Notice of Termination for Stormwater Discharges Associated with Industrial Activity Under the NPDES Multi-Sector General Permit NPDES Form Date (01/21) Expiration Date (MM/YY) This Form Replaces Form 3510-7 (06/15) Form OMB No. 2040-0300
Submitting Your Form If you have been granted a waiver from your Regional Office to submit a paper NOT form, you must send your NOT by mail to one of the following addresses: For Regular U.S. Mail Delivery: Stormwater Notice Processing Center Mail Code 4203M, ATTN: 2020 MSGP Reports U.S. EPA 1200 Pennsylvania Avenue, NW Washington, DC 20460	For Overnight/Express Mail Delivery: Stormwater Notice Processing Center William Jefferson Clinton East Building - Room 7420 ATTN: 2020 MSGP Reports U.S. EPA 1201 Constitution Avenue, NW Washington, DC 20004 Visit this website for instructions on how to submit electronically: https://www.epa.gov/npdes/stormwater-discharges-industrial-activities

NPDES Form 3510-7 Page H-3 of 9