2018-02-02_REVISION - C1981019 (9)

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COLORADO WATER QUALITY CONTROL DIVISION NOTICE OF TERMINATION www:roloraclowaterliermits.coni PART D. TERMINATION VALIDATION CRITERIA One of the criteria (1 or 2) below must be met, the appropriate box checked, and the required additional information provided. Part E includes a certification that the criteria indicated has been met. 1: Finally Stabilized or Construction Not Started - The permitted activities covered under the certification listed in Part A meet the requirements for FINAL STABILIZATION in accordance with the permit, the Stormwater Management Plan, and as described below. This criterion should also be selected if construction was never started and no land was disturbed, and an explanation of this condition provided in the description below. Final stabilization is reached when: all ground surface disturbing activities at the site have been completed including removal of all temporary erosion and sediment control measure, and uniform vegetative cover has been established with an individual plant density of at least 70 percent of precilsturbance levels, or equivalent permanent, physical erosion reduction methods have been employed, REQUIRED for Criteria 1- Describe the methods used to meet the final stabilization c described above: Include an attachment if additional space is required. -OR- 2: Separate Permit Coverage or Full Reassignment - All ongoing construction activities, including all disturbed areas, covered under the permit certification listed in Part A have coverage under a separate CDPS stormwater construction permit, including the permit certification issued when Division's Reassignment Form was used by the permittee to reassign all areas/activities. RECC,UIRE D for Criteria 2 — Provide the permit certification number covering the ongoing activities: COR03 One of the two criteria above MUST BE CHECKED and the required information for that criterion provided, i STOP! or this form will not be processed and the permit will remain active, • PART E. CERTIFICATION SIGNATURE Reqjiirgd for all Termination Requests) I understand that by submitting this notice of inactivation, I am no longer authorized to discharge stormwater associated with construction activity by the general permit, I understand that discharging pollutants in stormwater associated with construction activities to the waters of the State of Colorado, where such discharges are not authorized by a CDPS permit, is unlawful under the Colorado Water Quality Control Act and the Clean Water Act. I certify under penalty of law that I have personally examined and am familiar with the information submitted herein, and based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the information is true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment. (See 18 U.S.0 1001 and 33 U.S.C. 1319,) I also certify that I am a duly authorized representative of the permittee named in Part B. Signature of Legally Responsible Party Date Signed Name (printed) Title Signatory requirements: This form shall be signed, dated, and certified for accuracy by the permittee In accordance with the following criteria: 1. In the case of a corporation, by a principal executive officer of at least the level of vice-president, or his or her duly authorized representative, if such representative Is responsible for the overall operation of the operation from which the discharge described herein originates; 2. In the case of a partnership, by a general partner; 3. In the case of a sole proprietorship, by the proprietor; 4. In the case of a municipal, state, or other public operation, by wither a principal executive officer, ranking elected official, or other duly authorized employee. Page 2 of 2 form last revised July 2009