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Eastern Washington Phase H Allunicipal Storn7ii ater Permit <br />APPENDIX 5 - Notice of Intent (NOI) for Coverage <br />under a National Pollutant Discharge <br />DEPARTMENT OF Elimination System NPDES <br />ECOLOGY y } <br />State of Washington Municipal Stormwater General Permit <br />Introduction <br />This form must be used by all entities seeking initial coverage under one or more of the following <br />municipal separate storm sewer permits: <br />■ Phase I Municipal Stormwater Permit — "National Pollutant Discharge Elimination System <br />and State Waste Discharge General Permit for Discharges from Large and Medium Municipal <br />Separate Storm Sewer Systems" <br />Western Washington Phase II Municipal Stormwater Permit — "National Pollutant <br />Discharge Elimination System and State Waste Discharge General Permit for Discharges from <br />Small Municipal Separate Storm Sewers in Western Washington" <br />■ Eastern Washington Phase II Municipal Stormwater Permit — "National Pollutant <br />Discharge Elimination System and State Waste Discharge General Permit for Discharges from <br />Small Municipal Separate Storm Sewers in Eastern Washington" <br />The Department of Ecology (Ecology) will use the information provided to determine if coverage <br />under one or more of the above municipal stormwater general permits is required and/or appropriate. <br />Please answer all questions accurately and completely. If a question does not apply, answer NA to that <br />question. See instructions at the back of the form for more information. <br />Operators of municipal separate storm sewer systems (MS4s) seeking permit coverage must complete <br />this application and return it to Ecology. You may print this form and complete it by hand, or <br />download the form from Ecology's Web site and fill it out electronically. The form is available at: <br />www.ccv.wa.gov/biblio/ecy07O2O7.htm]. <br />A certified signature is needed to complete the application. Please reference supporting documents in <br />the text and attach as necessary. <br />Mail completed NOI to: <br />Department of Ecology <br />Water Quality Program <br />Municipal Stormwater Permits <br />P.O. Box 47696 <br />Olympia, WA 98504-7696 <br />Ecology will send each applicant an acknowledgment of receipt. If you have questions about this <br />application, please contact the appropriate Ecology employee listed at <br />www.ec .wa. ov/ ro ams/w /stonnwater/munici al/municontacts.html , or call Ecology's Water <br />Quality Program at 360-407-6600. <br />August 1, 2014 Appendix 5 - Afoticc of Intens for Coivrage Page 1 of 5 <br />