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eNOT MS4 Acceptance 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. Traditional Land Use Control MS4 Operator Information a. Name of MS4 Operator: b. MS4 SPDES Permit ID Number: NYR20A c. Street Address: d. City/State/Zip: e. Telephone Number: IV. Certification Statement I have determined that it is acceptable for the owner or operator of the construction project identified above to submit the electronic Notice of Termination in accordance with CGP Part V. 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 principal executive officer or ranking elected official for the MS4 Operator or their duly authorized representative in accordance with CGP Part VII.J.2.: b. Title/Position: c. Signature: d. Date: Page 804 of 849