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New York State Department of Environmental Conservation Division of Water 625 Broadway, 4th Floor Albany, New York 12233-3505 *(NOTE: Submit completed form to address above)* NOTICE OF TERMINATION for Storm Water Discharges Authorized under the SPDES General Permit for Construction Activity Please indicate your permit identification number: NYR ___ ___ ___ ___ ___ ___ I. Owner or Operator Information 1. Owner/Operator Name: 2. Street Address: 3. City/State/Zip: 4. Contact Person: 4a.Telephone: 4b. Contact Person E-Mail: II. Project Site Information 5. Project/Site Name: 6. Street Address: 7. City/Zip: 8. County: III. Reason for Termination 9a. □ All disturbed areas have achieved final stabilization in accordance with the general permit and SWPPP. *Date final stabilization completed (month/year): 9b. □ Permit coverage has been transferred to new owner/operator. Indicate new owner/operator’s permit identification number: NYR ___ ___ ___ ___ ___ ___ (Note: Permit coverage can not be terminated by owner identified in I.1. above until new owner/operator obtains coverage under the general permit) 9c. □ Other (Explain on Page 2) IV. Final Site Information: 10a. Did this construction activity require the development of a SWPPP that includes post-construction stormwater management practices? □ yes □ no ( If no, go to question 10f.) 10b. Have all post-construction stormwater management practices included in the final SWPPP been constructed? □ yes □ no (If no, explain on Page 2) 10c. Identify the entity responsible for long-term operation and maintenance of practice(s)? Page 1 of 3 Page 960 of 1174