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Owner/Operator Certification Form SPDES General Permit for Stormwater Discharges from Construction Activity, GP-0-25-001 (CGP) (In accordance with CGP Part I.D.2.b. or Part I.F.2. and 3., the completed form must be attached to the eNOI or the Request to Continue Coverage, and submitted to NYSDEC electronically. Project/Site Name: ________________________________________________________ eNOI Submission ID: _________________________________________________ eNOI Submitted by: Owner/Operator SWPPP Preparer Other Certification Statement - Owner/Operator I hereby certify that I read, and will comply with, the GP-0-25-001 permit requirements. I understand that authorization to discharge under the permit for the project/site named above is dependent on receipt of a Letter of Authorization (LOA) or a Letter of Continued Coverage (LOCC) from the New York State Department of Environmental Conservation (NYSDEC) in accordance with CGP Part I.D.3.b. or Part I.F.4. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. Owner/Operator First Name MI Owner/Operator Last Name ___________________________________________________________ Signature ________________________________ Date Revised: January 2025 Page 153 of 359