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STAT OF COLORADO <br />Dedicated to protecting and improving the health and envir <br />4300 Cherry Creek Dr. S. <br />of '70 <br />� (. ..... 9 <br />Denver, Colorado 80246 -1530 <br />A AIL i i y <br />ceased; has a 30 day Public Notice Period prior to termination a <br />P approval; and may require bond <br />release for mining discharge <br />Phone (303) 692 -2000 <br />permits. Termination for these permits also require up to date submissions <br />a <br />TDD Lane (303) 691 -T/00 <br />CE'4P <br />the terminatio date of the permit. <br />Located in Glendale, Colorado <br />• PRETREATMENT Generally requires inspection by the Division to ensure discharges have ceased. <br />Colorado Department <br />http: / /www.cdphe.state.co -us <br />�[ <br />got,4 _ <br />of Public Health <br />and Environment <br />FOR DIVISION USE ONLY <br />CERTIFICATION NUMBER FOR <br />PERMITS CONVERTED TO <br />STORMWATER ONLY <br />- ---��- <br />VVMV A R 0k ] %bM �tv <br />u- r U I KUL VIVINUN NOTICE OF TERMINATION <br />Please print or type all information. Mail oriigina f y i ignatures to the following address. Emailed and Faxed forms will <br />not be accepted. All items must be filled out completely and correctly. If the form is not complete, it will be returned <br />Colorado Dept of Public Health and Environment <br />Water Quality Control Division <br />4300 Cherry Creek Dr South WQCD -P -B2 <br />Denver, CO 80246 -1530 <br />PART A . IDENTIFICATION PERMIT /CERTIFICATION AUTHORIZATION TYPE & TERMINATION PROCESS APPLIED BY THE DIVISION <br />PLEASE LIMIT SUBMISSION TO ONE PERMIT OR CERTIFICATION / FORM <br />All Permit Termination Dates are Effective on the date approved by the Division. <br />Please wr the ann ntimhar in tho hinnL .,..,..;A-A + aL, i <br />- - - - -- -- r---. . .... .. ... .. .• .., .. .. Nc�nuy �crun ll/I.JC. <br />1. INDIVIDUAL PERMIT <br />Permit Number <br />Termination for an individual permit generally requires inspection by the Division to ensure discharges <br />have <br />A AIL i i y <br />ceased; has a 30 day Public Notice Period prior to termination a <br />P approval; and may require bond <br />release for mining discharge <br />CO G- 8 5 003 C <br />permits. Termination for these permits also require up to date submissions <br />of all annual reports, discharge monitoring reports, or other reporting paperwork for the period prior to <br />CE'4P <br />the terminatio date of the permit. <br />C0Ct F, r j 0 c c c <br />• PRETREATMENT Generally requires inspection by the Division to ensure discharges have ceased. <br />Permit Number <br />Termination for these permits also require up to date submissions of all annual reports, discharge <br />COG607000 <br />monitoring reports, or other reporting paperwork for the period prior to the termination date of the <br />perm <br />COR010000 <br />e.. a,rR i irn,Hi wry UIVULK A bLNEKAL PERMIT <br />a. Termination for certifications under one of these general permits is based on self - certifying information <br />Termination for these certifications also require up to date submissions of all annual reports, dischorae monitoring resorts. nr <br />-- — L111­L.V1 j UI IUCf une of Lnese general permits generally requires an inspection by the Division to ensure <br />discharges have ceased. Termination for these certifications also require up to date submissions of nil nnnr,nl rannrtc <br />W rier reporrmg pa jor t he p eriod prior to the termination date of the permi <br />1. <br />COG070000 <br />Construction De- watering. <br />Cert/Facility Number <br />2. <br />COG603000 <br />Subterranean Dewatering or Well development <br />3. <br />COG604000 <br />Hydrostatic Testing <br />4. <br />COG607000 <br />Commercial Washing of Outdoor Structures <br />5. <br />COR010000 <br />Light Industry Activities - Stormwater <br />6. <br />COR020000 <br />Heavy Industry Activities - Stormwater <br />7. <br />COR060000 <br />Recycling Industry Activities - Stormwater <br />8. <br />NOX000000 <br />No Exposur Exclusi - - Stormwate <br />9. <br />COX621000 <br />Domestic Wastewater Treatment > 2000gpd - Groundwater <br />-- — L111­L.V1 j UI IUCf une of Lnese general permits generally requires an inspection by the Division to ensure <br />discharges have ceased. Termination for these certifications also require up to date submissions of nil nnnr,nl rannrtc <br />Page 1 of 5 form last revised March 2010 <br />aiscnarge monitoring reports, or other reporting pa for t he p eriod prio to the termination date of the permit. <br />1. <br />COG130000 <br />Aquatic Animal Production <br />Cert/Facility Number <br />COG315000 <br />Groundwater Remediation <br />3. <br />COG588000 <br />Domestic WWTF 100:1 Dilution <br />4. <br />COG589000 <br />Domestic WWTF Surface Water <br />5. <br />COG600000 <br />Minimal Industrial Wastewater Discharge <br />6. <br />COG605000 <br />Non - Contact Cooling Water <br />7. <br />COG641000 <br />Water Treatment Plant Wastewater Discharges <br />8. <br />COG840000 <br />Produced Water Treatment Facility <br />9. <br />COX621000 <br />Domestic Wastewater Treatment > 2000gpd - Groundwater <br />10. <br />COX622000 <br />Domestic WW Treatment -no GW Monitoring Requirements - Groundwater <br />11. <br />COX631000 <br />Domestic WW Treatment System - Land Disposal - Groundwater <br />12. <br />COX632000 <br />Domestic WW Treatment System - Land Treatment - Groundwater <br />13. <br />COX633000 <br />Domestic WW Treatment System - Land Treatment /Agronomic rate - Groundwater <br />Page 1 of 5 form last revised March 2010 <br />