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eNOT Qualified Inspector Certification – SMPs for construction activities seeking termination from the SPDES General Permit for Stormwater Discharges from Construction Activity, GP-0-25-001 (CGP) (The completed form must be attached to the eNOT, which must be submitted to NYSDEC electronically in accordance with CGP Part V.A.5.) I. Project Owner/Operator Information a. Owner/Operator Name: b. Contact Person: c. Street Address: d. City/State/Zip: II. Project Site Information a. Project/Site Name: b. Street Address: c. City/State/Zip: d. CGP SPDES Permit ID: III. Certification Statement I hereby certify that all the requirements in CGP Part V.A.1.a.iv. or CGP Part V.A.1.b.iv. have been achieved. I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. a. Printed name of the Qualified Inspector: b. Title/Position: c. Signature: d. Date: Page 158 of 359