1. PAG-15
      2. COMMONWEALTH OF PENNSYLVANIA FROM THE
      3. APPLICATION OF PESTICIDES
      4. NOTICE OF INTENT (NOI)

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
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
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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