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COLORADO WATER QUALITY CONTROL DIVISION NOTICE OF TERMINATION www.coloradowatervermits.com <br />D.2. FACILITY IS IN NOT IN OPERATION AT THIS LOCATION <br />Respond to one of the 5sections: <br />1. FACILTY IS NOT IN OPERATION <br />All other permit types, certifications, etc., listed in Part A — Identification of Permit <br />Wastewater previously authorized for Discharge by the Division has been properly disposed of and all <br />discharges have ceased <br />❑ YES Go to Part E. Certification & Signature <br />2. FACILITY IS NOT IN OPERATION and is a STORMWATER INDUSTRIAL <br />(Light Industry, Heavy Industry, Recycling Industry, or No Exposure Exclusion) <br />All industrial activity at the identified site has ceased; all potential pollutant sources have been removed; <br />all industrial wastes have been disposed of properly and all elements of the Stormwater Management Plan <br />have been completed. <br />❑ YES Go to Part E. Certification & Signature <br />3. FACILITY IS NOT IN OPERATION and is a MINING OPERATION <br />(Sand & Gravel, Metal Mining, Coal Mining, or Hard Rock Mining) <br />❑ a. Reclamation for mining site (coal, metal, sand & gravel) is complete; <br />Bond release from DRMS has been received and a copy of the release letter is attached. (If release <br />letter is not attached, termination of this permit will be delayed.) <br />❑ b. Reclamation for mining site is complete. There was no bond required by the DRMS for this permit <br />Go to Part E. Certification & Signature <br />❑ c. Reclamation of the site is not complete. The DRMS Bond has not been released. This is a request <br />for Stormwater ONLY permit. Go to Part E. Certification & Signature <br />d. Reclamation of mining site is complete - Is there any continued mine drainage? <br />e.g. adits or unreclaimed waste piles? <br />❑ YES Please Explain (Attach additional pages as necessary.) <br />❑ NO Go to Part E. Certification & Signature <br />4. FACILITY IS NOT IN OPERATION and is REUSE USER - <br />Reclaimed water is no longer being used at the site and the connection has been severed? <br />❑ YES Go to Part E. Certification & Signature <br />5. FACILITY IS NOT IN OPERATION and is a BIOSOLIDS Land Application Site - <br />Land application at the site has been discontinued and final reporting on cumulative application has <br />been submitted? <br />❑ YES Go to Part E. Certification & Signature <br />Page 4 o 5 form fast revised March 2010 <br />