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COLORADO WATER QUALITY CONTROL DIVISION NOTICE OF TERMINATION www.coloradowaterpermits.com <br />D.2. FACC L7Y aS IN NOT IN OPERAPON A7 7E15 L(3CA7QN <br />Respond to one of the 5 sections: <br />2. FACILTY IS NOT IN OPERATION <br />A8I 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. Certificaticn & Signature <br />2. EFACIUTY IS INOT 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 Storrnwater 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 />QSand & Gravel, Fetal Mining, Coal IVliining, or Hard Rock Mining) <br />❑ a. Reclaration for mining site Qcoal, metal, sand & gravel) is complete; <br />Bond release from DRMS has been received and a copy of the release lettei 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. IFA(JLITY 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 F. Certification & Signature <br />S. ;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 />V_l <br />YES Go to Part E. Certification & Signature <br />Page 4 of 5 form last revised March 2010 <br />