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Home My WebLink AboutWater Quality Control Termination ApplicationCOLORADO Department of Public Health & Environment Dedicated to protecting and improving the health and environment of the people of Colorado FOR DIVIISION USE ONLY Effective date Print or type all information. Mail original form with ink signature to the following address. Emailed and Faxed forms will not be accepted. All items must be filled out completely and correctly. If the form is not complete, you will be asked to resubmit it. Colorado Dept of Public Health and Environment Water Quality Control Division WQCD-P-B2 4300 Cherry Creek Drive South Denver CO 80246-1530 PART A. IDENTIFICATION OF PERMIT OR AUTHORIZATION - Please limit submission to one permit, certification, or authorization per form. All permit termination dates are effective on the date approved by the division. Processing times vary by type of discharge. Some discharge types require onsite inspections to verify information in this application. PERMIT, CERTIFICATION, OR AUTHORIZATION NUMBER (DOES NOT END IN 0000) COR03P332 PART B. PERMITTEE INFORMATION Company Name Public Service Company of Colorado Legal Contact First Name Quinn Last Name Kilty Title Manager of Environmental Services Mailing Address 1800 Larimer Street, Suite 1300 City Denver State CO Zip Code 80202 Phone 303-294-2165 Email address quinn.v.kilty@xcelenergy.com PART C. FACILITY OR PROJECT INFORMATION Facility/ Project name PSCO Parachute Substation Location/Address 10601 Hwy 6 and Hwy 24 City Parachute Local contact name David Vara Phone 303-628-2809 County Garfield Title Construction Supervisor Email address david.r.vara@xcelenergy.com PART D. TERMINATION INFORMATION QUESTIONS Provide information for Part D that applies to your facility and termination request. Not all questions need to be answered- only the part that applies to your facility. Part D1 covers facilities no longer in operation. Part D2 covers mining facilities no longer in operation Part D3 covers facilities in operation but no longer discharging or needing permit coverage. Part D4 covers Stormwater Construction facilities where construction is complete and the site is stabilized. "Please answer questions as completely as possible to assist in timely approval of this termination request." 1. FACILITY IS NO LONGER IN OPERATION AT THIS LOCATION All activities and discharges at the identified site have ceased; all potential pollutant sources have been removed; all industrial wastes have been disposed of properly; all DMR's, Annual Reports, and other reports have been submitted; and all elements of a Stormwater Management Plan have been completed (if this applies). Treatment Works Closure at Wastewater Treatment Facilities Page 1 of 3 Dec 2014 D2. MINING FACILITY IS NO LONGER IN OPERATION AT THIS LOCATION. Sand and Gravel, Coal or Hard Rock Mining FIA. Mining operation is no longer discharging process/treated water. Bond has not been released by DRMS A stormwater only permit is requested at this time. Attach application for Stormwater Only permit. B. Recla n of mining site is completed. Bond has been r sed by DRMS. YES Attach a copy of the Bond release letter. 0 Explain below: C. Reclamation ining site is complete. Is there any continued mine drainage? Eg. Adits or unreclaimed waste piles? Please explain, attach additional pages as necessary. D3. FACILITY IS STILL IN OPERATION BUT IS NO LONGER DISCHARGING OR NO LONGER NEEDS A PERMIT ❑A. Facility continues to operate, however the activity producing the discharge has ceased (including changes in SIC Code resulting in change in duty to apply). FIB. Termination is based on alternate disposal of discharges (discharge is being disposed of in another way) Solid waste disposal unit (e.g. evaporative ponds) No Exposure Exclusion (for industrial stormwater facilities only.) NOX Number Combined with another authorized discharge. Permit Number Permit is not required (includes coverage by low risk policy, etc.) - please explain, attach additional pages if necessary C. PERMITTEE IS NO LONGER THE OWNER/OPERATOR OF THE SITE and all efforts have been made to transfer the permit to appropriate parties. Please attach copies of registered mail receipts, letters, D4. STORMWATER CONSTRUCTION FACILITIES WHERE CONSTRUCTION IS COMPLETE (Select A, B, or C) A. SITE IS FINALLY STABILIZED OR CONSTRUCTION WAS NOT STARTED The permitted activities meet the requirements for FINAL stabilization in accordance with the permit, the Stormwater Management Plan, and as described in item b. (explanation can be construction activities were not started). Describe the methods used to meet final stabilization. (Required) Active construction has been completed and the site has been stabilized via hardscape gravel. `Final Stabilization defined on page 3 Page 2 of 3 Dec 2014 D4. STORMWATER CONSTRUCTION FACILITIES WHERE CONSTRUCTION IS COMPLETE (Continued) B. ALTERNATIVE PERMIT COVERAGE OR FULL REASSIGNMENT All ongoing construction activities including all disturbed areas, covered under the permit certification listed in Part B have coverage under a separate CDPS Stomwater Construction permit. The Division's Reassignment form was used by the permittee to reassign all areas and activities. Permit certification number covering the ongoing activities (Required) C. PERMITTEE IS NO LONGER THE OWNER OR OPERATOR OF THE FACILITY All efforts have been made to transfer the permit to appropriate parties. Please attach copies of registered mail receipt, letters, etc. *Final stabilization is reached when: all ground surface disturbing activities at the site have been completed including removal of all temporary erosion and sediment control measure, and uniform vegetative cover has been established with an individual plant density of at least 70 percent of predisturbance levels, or equivalent permanent, physical erosion reduction methods have been employed. PART E. CERTIFICATION SIGNATURE REQUIRED FOR ALL TERMINATION REQUESTS I certify under penalty of law that this document and all attachments were prepared under my direction and/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 individuals immediately 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. " (See 18 USC 1001 and 33 USC 1319) I certify that I am the legal representative of the above named company (PART B page 1). I understand that by submitting this notice of termination, I am no longer authorized to discharge stormwater associated with construction activity by the general permit. I understand that discharging pollutants in stormwater associated with construction activities to the waters of the State of Colorado. where such discharges are not authorized by a CDPS permit, is unlawful under the Colorado Water Quality Control Act and the Clean Water Act. Quinn Kilty Name (printed) Manager of Environmental Services Signatory requirements: This termination request shall be signed, dated, and certified for accuracy by the permittee in accord with the following criteria: In the case of a corporation, by a principal executive officer of at least the level of vice-president, or his or her duly authorized representative, if such representative is responsible for the overall operation of the operation from which the discharge described herein originates; 2 In the case of a partnership, by a general partner; 3 In the case of a sole proprietorship, by the proprietor; 4 In the case of a municipal, state, or other public operation, by either a principal executive officer, ranking elected official, or other duly authorized employee. Page 3 of 3 Dec 2014