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MS4 SWPPP Acceptance Form for construction activities seeking authorization under the SPDES General Permit for Stormwater Discharges from Construction Activity, GP-0-25-001 (CGP) (In accordance with CGP Part I.D.2.b., the completed form must be attached to the eNOI and submitted to NYSDEC electronically.) I. Project Owner/Operator Information 1. Owner/Operator Name: 2. Contact Person: 3. Street Address: 4. City/State/Zip: II. Project Site Information 5. Project/Site Name: 6. Street Address: 7. City/State/Zip: III. Stormwater Pollution Prevention Plan (SWPPP) Review and Acceptance Information 8. SWPPP Reviewed by: 9. Title/Position: 10. Date Final SWPPP Reviewed and Accepted: IV. Regulated MS4 Information 11. Name of MS4 Operator: 12. MS4 SPDES Permit Identification Number: NYR20A 13. Street Address: 14. City/State/Zip: 15. Telephone Number: Page 1 of 2 Page 150 of 359