VPDES General Permit for Nonmetallic Mineral Mining (VAG84)
Notice of Termination
(Please Type or Print All Information)1.Owner Information
Name:Mailing Address:
City: / State: / Zip: / Phone:
Email Address (where available):
2.Facility Information
Name:Address:
City: / State: / Zip:
3.VPDES General Nonmetallic Mineral Mining Permit Number:
- Check the appropriate box indicating the reason for terminating coverage under the general permit.
A new owner has assumed responsibility for the facility (NOTE: This termination notice does not have to be submitted if a VPDES Change of Ownership Agreement Form has been submitted).
Operations have ceased at the facility and there are no longer discharges of process wastewater or stormwater associated with industrial activity from the facility.
All process wastewater or stormwater discharges associated with industrial activity have been covered by an individual VPDES permit.
Other (specify)
5.Certification:"I certify under penalty of law that all wastewater and stormwater discharges from the identified facility that are authorized by this VPDES general permit have been eliminated, or covered under a VPDES individual or alternative permit, or that I am no longer the owner of the facility, or permit coverage should be terminated for another reason listed above. I understand that by submitting this Notice of Termination, that I am no longer authorized to discharge nonmetallic mineral mining wastewater or stormwater in accordance with the general permit, and that discharging pollutants to surface waters is unlawful where the discharge is not authorized by a VPDES permit. I also understand that the submittal of this notice of termination does not release an owner from liability for any violations of this permit or the Clean Water Act."
Print Name / Title:Signature: / Date:
Phone Number: / Email Address:
For Department of Environmental Quality Use Only
Accepted/Not Accepted by: / Date:
Notice of Termination Nonmetallic Mineral Mining (7/14)
NOTICE OF TERMINATION INSTRUCTIONS T
VPDES General Permit forNonmetallic Mineral Mining (VAG84)
WHEN SHOULD A NOTICE OF TERMINATION BE FILED?
A VPDES General Permit Notice of Termination may be submitted when an owner no longer wishes to be covered under the VPDES General Permit for Nonmetallic Mineral Mining (VAG84).
Section 1Facility Owner Information
Give the legal name of the person, firm, public organization, or other entity that owns the facility or site described in this Notice of Termination and was issued the general permit for the facility. The name of the owner may or may not be the same as the name of the facility. Do not use a colloquial name. Enter the complete address, phone number and email address (where available) of the owner.
Section 2Facility Location Information
Enter the facility's or site's official name and complete street address, including city, state and ZIP code.
Section 3Permit Information
Enter the existing VPDES Nonmetallic Mineral Mining General Permit number assigned to the facility or site identified in Section 2.
Section 4Reason for Termination
Check the appropriate statement indicating the reason for submitting this Notice of Termination.
Section 5Certification
State statutes provide for severe penalties for submitting false information on this Termination Notice. State regulations require this Notice of Termination to be signed as follows:
For a corporation: by a responsible corporate officer. For the purpose of this section, a responsible corporate officer means: (1) A president, secretary, treasurer, or vice-president of the corporation in charge of a principal business function, or any other person who performs similar policy- or decision-making functions for the corporation, or (2) the manager of one or more manufacturing, production, or operating facilities provided the manager is authorized to make management decisions which govern the operation of the regulated facility including having the explicit or implicit duty of making major capital investment recommendations, and initiating and directing other comprehensive measures to assure long term environmental compliance with environmental laws and regulations; the manager can ensure that the necessary systems are established or actions taken to gather complete and accurate information for permit application requirements; and where authority to sign documents has been assigned or delegated to the manager in accordance with corporate procedures;
For a partnership or sole proprietorship: by a general partner or the proprietor; or
For a municipality, state, Federal, or other public facility: by either a principal executive officer or ranking elected official.
The Department of Environmental Quality reserves the right to request additional information not directly addressed by the Notice of Termination if, in its discretion, a facility or operation poses a potential impact on water quality.
Notice of Termination Nonmetallic Mineral Mining (7/14)