3800-PM-BPNPSM0345c 8/2012  COMMONWEALTH OF PENNSYLVANIA
    Checklist  DEPARTMENT OF ENVIRONMENTAL PROTECTION

    BUREAU OF POINT AND NON-POINT SOURCE MANAGEMENT

     


     
    PAG-15
    NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)

     
    GENERAL PERMIT FOR POINT SOURCE DISCHARGES TO WATERS OF THE COMMONWEALTH OF PENNSYLVANIA FROM THE
    APPLICATION OF PESTICIDES
    NOTICE OF INTENT (NOI)
     
    APPLICANT'S ü CHECKLIST
     
     
    APPLICANT NAME      
    Check the following list to make sure you have included all the required information. Place a checkmark in the box provided for all items completed and/or provided. Failure to provide all of the requested information will delay the processing of the NOI.

    ENCLOSE THIS CHECKLIST WITH YOUR COMPLETED NOI.

    REQUIREMENTS FOR ALL DISCHARGES
    Check ü
    If

    Included

    DEP Use Only
    1.
    Three (3) copies of the completed, signed NOI (3800-PM-WSFR0345b)
     
         
    2.
    NOI filing fee ($250) made payable to “Commonwealth of Pennsylvania”
     
         
    3.
    Treatment Area with Topographic Map
     
         
    4.
    Pesticide Discharge Management Plan (see Appendix D of General Permit)
     
         

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