2021 Multi-Sector General Permit (MSGP) - Appendix H

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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 No Exposure
Certification (NEC) form. However, if you are given a waiver by the EPA Regional Office to use a paper
NEC form, and you elect to use it, you must complete and submit the following form.

NPDES Form 3510-7

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Appendix H – Notice of Termination (NOT) Form

2021 MSGP

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

NPDES
FORM
3510-7

OMB No. 2040-0004
Exp. Date: 7/31/2026

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.

A. Approval to Use Paper NOT Form
1. Have you been granted a waiver from electronic reporting from the EPA 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

B. 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.

C. Facility Operator Information
1. Operator Name:
2. Mailing Address:
Street:
City:
3. Phone:

-

-

State:

ZIP Code:

State:

ZIP Code:

-

Ext.

4. E-mail:

D. Facility Information
1. Facility Name:
2, Facility Address:
Street:
City:

-

County or Similar Government Subdivision:

NPDES Form 3510-7

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2021 MSGP

Appendix H – Notice of Termination (NOT) Form

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, Last Name
Title:
Signature:

Date:

/

/

E-mail:

NPDES Form 3510-7

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Appendix H – Notice of Termination (NOT) Form

2021 MSGP

Instructions for Completing EPA Form 3510-7
Notice of Termination for Stormwater Discharges
Associated with Industrial Activity Under the NPDES Multi-Sector General Permit
This Form Replaces Form 3510-7 (06/15) Form OMB No. 2040-0004
Who May File Notice of Termination (NOT) Form
Permittees currently covered by EPA’s NPDES Stormwater MultiSector 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 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.

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.

For a partnership or sole proprietorship: By a general partner or the
proprietor, respectively; or

Section B. Permit Information
Enter the existing NPDES ID (i.e., NOI tracking number) assigned to your
permit authorization.

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.

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).

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.
2040-0004). 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.

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.

NPDES Form 3510-7

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.

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Appendix H – Notice of Termination (NOT) Form

2021 MSGP

Instructions for Completing EPA Form 3510-7
Notice of Termination for Stormwater Discharges
Associated with Industrial Activity Under the NPDES Multi-Sector General Permit
This Form Replaces Form 3510-7 (06/15) Form OMB No. 2040-0004
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

NPDES Form 3510-7

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-industrialactivities

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