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THE CITY OF NEW YORK DEPARTMENT OF ENVIRONMENTAL PROTECTION Bureau of Environmental Planning and Analysis 59-17 Junction Blvd., 9th Floor; Flushing, NY 11373 SWPPP Acceptance/Approval Application Number: 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/Approval 8. SWPPP Reviewed by: 9. Title/Position: / 10. Date Final SWPPP Reviewed and Accepted: 11. Acceptance/Approval Expiration Date: IV. Regulated MS4 Information for projects that require coverage under the NY State Pollution Discharge Elimination System General Permit for Stormwater Discharges from Construction Activity 12. Name of MS4: CITY OF NEW YORK 13. MS4 SPDES Permit Identification Number: NY-0287890 14. Contact Person: 15. Street Address: 59-17 Junction Blvd. 9th Floor 16. City/State/Zip: Flushing, NY 11373 17. Telephone Number: Projects in the MS4 area must submit a copy of this SWPPP Acceptance with a Notice of Intent for coverage under the NY SPDES General Permit for Stormwater Discharges from Construction Activity to: NYS Department of Environmental Conservation, Division of Water; 625 Broadway, 4th Floor; Albany, New York 12233-3505. Page 793 of 849 Page 1 Of 2