THIS FORM REPLACES PREVIOUS FORM 3510-7 (8-92)

Please See Instructions Before Completing This Form

Form Approved. OMB No. 2040-0086 

Approved expires: 8-31-98 

NPDES 

FORM 

United States Environmental Protection Agency 

Washington, DC 20460 

Notice of Termination (NOT) of Coverage Under a NPDES General Permit for Storm Water Discharges Associated

with Industrial Activity.

Submission of this Notice of Termination constitutes notice that the party identified in Section II of this form is no longer authorized to discharge storm water associated 

with industrial activity under the NPDES program. ALL NECESSARY INFORMATION MUST BE PROVIDED ON THIS FORM.

I. Permit Information 

NPDES Storm Water 

General Permit Number: 

Check Here if You are No Longer 

the Operator of the Facility: 

Check Here if the Storm Water 

Discharge is Being Terminated: 

II. Facility Operator Information 

Name: Phone: 

Address: 

City: State: Zip Code: -

III. Facility/Site Location Information 

Name:

Address: 

City: State: Zip Code: -

Latitude: Longitude: Quarter: Section: Township: Range:

IV. Certification: I certify under penalty of law that all storm water discharges associated with industrial activity from the identified facility that are authorized by a 

NPDES general permit have been eliminated or that I am no longer the operator of the facility or construction site. I understand that by submitting this Notice of 

Termination, I am no longer authorized to discharge storm water associated with industrial activity under this general permit, and that discharging pollutants in storm 

water associated with industrial activity to waters of the United States is unlawful under the Clean Water Act where the discharge is not authorized by a NPDES permit. 

I also understand that the submittal of this Notice of Termination does not release an operator from liability for any violations of this permit or the Clean Water Act. 

Print Name: Date: 

Signature: _________________________________________________________________________________

Instructions for Completing Notice of Termination (NOT) Form 

Who May File a Notice of Termination (NOT) Form Where to File NOT Form 

NOTs sent regular mail:

Stromwater Notice of Termination (4203M) 

USEPA 

1200 Pennsylvania Avenue, NW 

Washington, D.C. 20460 

NOTs sent overnight/express:

Stromwater Notice of Termination 

US EPA East Building, Rm. 7420 

1201 Constitution Avenue, NW 

Washington, D.C. 20004 

(202) 564-9545 

Completing the Form 

Permittees who are presently covered under an EPA-issued National Pollutant 

Discharge Elimination System (NPDES) General Permit (including the 1995 

Multi-Sector Permit) for Storm Water Discharges Associated with Industrial 

activity may submit a Notice of Termination (NOT) form when their facilities no 

longer have any storm water discharges associated with industrial activity as 

defined in the storm water regulations at 40 CFR 122.26(b)(14), or when they 

are no longer the operator of the facilities. 

For construction activities, elimination of all storm water discharges associated 

with industrial activity occurs when disturbed soils at the construction site have 

been finally stabilized and temporary erosion and sediment control measures 

have been removed or will be removed at an appropriate time, or that all storm 

water discharges associated with industrial activity from the construction site 

that are authorized by a NPDES general permit have otherwise been 

eliminated. Final stabilization means that all soil-disturbing activities at the site 

have been completed, and that a uniform perennial vegetative cover with a 

density of 70% of the cover for unpaved areas and areas not covered by 

permanent structures has been established, or equivalent permanent 

stabilization measures (such as the use of riprap, gabions, or geotextiles) 

have been employed. 

Type or print, using upper-case letters, in the appropriate areas only. Please place 

each character between the marks. Abbreviate if necessary to stay within the 

number of characters allowed for each item. Use only one space for breaks

between words, but not for punctuation marks unless they are needed to clarigy 

your response. If you have any questions about this form, telephone or write the 

Notice of Intent Processing Center at (866) 352-7755. 

EPA Form 3510-7 (8-98) 
Instructions-EPA Form 3510-7 

Notice of Termination (NOT) of Coverage Under The NPDES General Permit 

for Storm Water Discharges Associated With Industrial Activity 

Section I Permit Information 

Enter the existing NPDES Storm Water General Permit number assigned to the 

facility or site identified in Section III. If you do not know the permit number, 

telephone or write your EPA Regional storm water contact person. 

Indicate your reason for submitting this Notice of Termination by checking the 

appropriate box: 

 If there has been a change of operator and you are no longer the 

operator of the facility or site identified in Section III, check the 

corresponding box. 

 If all storm water discharges at the facility or site identified in Section III 

have been terminated, check the corresponding box. 

Section II Facility Operator Information 

Give the legal name of the person, firm, public organization, or any other entity 

that operates the facility or site described in this application. The name of the 

operator may or may not be the same name as the facility. The operator of the 

facility is the legal entity which controls the facility’s operation, rather than the 

plant or site manager. Do not use a colloquial name. Enter the complete address 

and telephone number of the operator. 

Section III Facility/Site Location Information 

Enter the facility’s or site’s official or legal name and complete address, including 

city, state, and ZIP code. If the facility lacks a street address, indicate the state, 

the latitude and longitude of the facility to the nearest 15 seconds, or the quarter, 

section, township, and range (to the nearest quarter section) of the approximate 

center of the site. 

Section IV Certification 

Federal statutes provide for severe penalties for submitting false information on 

this application form. Federal regulations require this application to be signed as 

follows: 

For a corporation: by a responsible corporate officer, which means: (i) 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, or (ii) the manager of one or more manufacturing, production, 

or operating facilities employing more that 250 persons or having gross annual 

sales or expenditures exceeding $25 million (in second-quarter 1980 dollars), if 

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. 

Paperwork Reduction Act Notice 

Public reporting burden for this application is estimated to average 0.5 hours per

application, including time for reviewing instructions, searching existing data 

sources, gathering and maintaining the data needed, and completing and 

reviewing the collection of information. Send comments regarding the burden 

estimate, any other aspect of the collection of information, or suggestions for

improving this form, including any suggestions which may increase or reduce this

burden to: Director, Office of Environmental Information Services, Collection

Services Division (2823), USEPA, 1200 Pennsylvania Avenue, NW, Washington,

DC 20460. Include the OMB control number of this form on any correspondence.

Do not send the completed NOT form to this address.