1. PAG-15
      2. NOTICE OF INTENT (NOI) INSTRUCTIONS

3800-PM-BPNPSM0345a Rev. 11/2012
Instructions NOI
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COMMONWEALTH OF PENNSYLVANIA
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) INSTRUCTIONS
In order to be covered under the General Permit, an Operator may not discharge to High Quality (HQ) or
Exceptional Value (EV) waters. Refer to 25 Pa. Code Chapter 93 for stream classifications.
GENERAL INFORMATION
NOTE: FAILURE TO COMPLY WITH THESE INSTRUCTIONS AND SUBMIT ALL REQUIRED INFORMATION
MAY RESULT IN DENIAL OF THE NOI.
To Obtain DEP Application Packages.
To expedite the processing of the applicant's request, the Department of
Environmental Protection (DEP) asks that the most up-to-date NOI package available be used. The most recent
version of this package can be obtained by contacting the appropriate DEP regional office or through the DEP
website. This package, as well as other DEP-wide and/or program-specific permit packages, is available in
Microsoft Word format at this same web location. Applicants can download the appropriate form to a personal
computer, complete the form electronically and print the document for submittal to DEP using the following steps:
Type in DEP's website address:
www.dep.state.pa.us
Select: Licensing, Permits & Certification
Select: Program-Specific Permit/Authorization Packages
Select: W
ater Management
Select: NPDES
Select: General Permits
Select: PAG-15
The General Information Form (GIF) is required for all new NOIs for coverage under the General Permit.
The GIF form can be obtained as follows:
Go to DEP's website: www.dep.state.pa.us
Select: Licensing, Permits and Certification
Select: Department-Wide Permit/Authorization Packages
Select: General Information Form (GIF)
FOLLOWING SUBMISSION OF YOUR NOI, CHECK DEP’s WEBSITE TO MONITOR THE STATUS OF YOUR
NOI.
In general, DEP will not notify you if the NOI is considered complete and technically adequate. You may view
the status of your NOI as follows:
Go to DEP's website: www.dep.state.pa.us
Select: Tools
Select: eFACTS
Select: Authorization Search and search for the record using the permit number. If unknown, you will need
to search using other criteria.
If necessary, contact DEP‟s HelpDesk for assistance at
717.705.3768.

3800-PM-BPNPSM0345a Rev. 11/2012
Instructions NOI
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General Instructions.
This package is designed to assist the applicant in completing the NOI form identified
above. Type or print clearly when completing the form. If the information requires more than the space allows,
attach additional sheets as necessary. If a question is not applicable to the project, write NA in the appropriate box.
The scope of the Pesticides General Permit is limited to application of pesticides which results in a discharge to
waters of the Commonwealth which are eligible for coverage under the terms and conditions of the General Permit.
Who may use this NOI?
This form may be used by eligible Operators (Decision-Makers) seeking coverage under
the Pesticides General Permit. For purposes of this permit, all Operators are defined as either an Applicator or a
Decision-Maker or both an Applicator and a Decision-Maker.
When an Operator is both an Applicator and a Decision-Maker, the Operator must comply with all applicable
requirements imposed on both Applicators and Decision-Makers. When the permit references “All Operators,” both
Applicators and Decision-Makers must comply.
The Decision-Maker who is required to submit an NOI (see Table 1) should file an administratively complete,
acceptable NOI with DEP at least 30 days prior to commencing any biological and chemical pesticide application
(see dates in Table 2) for the following use categories:
Pesticide Use Patterns
Mosquito and Other Flying Insect Pest Control
– to control public health/nuisance and other flying insect pests
that develop or are present during a portion of their life cycle in or above standing or flowing water. Public
health/nuisance and other flying insect pests in this use category include mosquitoes and black flies.
Weeds and Algae Pest Control
– to control weeds, algae, and pathogens that are pests in water and at water's
edge, including ditches, canals, and/or right-of-ways.
Animal Pest Control
– to control animals pests in water and at water‟s edge. Animal pests in this use category
include fish, lampreys, insects, mollusks, and pathogens.

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Instructions NOI
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Forest Canopy Pest Control
– application of a pesticide to a forest canopy to control the population of a pest
species (e.g., insect or pathogen) where, to target the pests effectively, a portion of the pesticide unavoidably will be
applied over and deposited to water.
Table 1. Decision-Makers Required to Submit NOIs
Pesticide Use
Decision-Makers Who Must Submit NOIs
Annual Treatment Area
Threshold
1
Mosquitoes and
Other Flying Insect
Pests
Federal and State agencies with a responsibility
to control mosquitoes for public health, nuisance
control, and animal welfare
All
Mosquito control districts, or similar pest control
districts
All
Other entities that exceed the annual treatment
area threshold identified here
Decision to treat with adulticide
during a calendar year more than
6,400 acres
2
Weed and Algae
Pests Control
Federal and State agencies with a responsibility
to control weeds and algae
All
Irrigation and weed control districts, or similar
pest control districts
All
Other entities that exceed the annual treatment
area threshold identified here
Decision to treat during a calendar
year more than either: 20 linear
miles OR
80 acres of water (i.e., surface
area)
3
Animal Pest
Control
Federal and State agencies with a responsibility
to control animals for public health, nuisance, or
resource management
All
Other entities that exceed the annual treatment
area threshold identified here
Decision to treat during a calendar
year more than either: 20 linear
miles OR
80 acres of water (i.e., surface
area)
4
Forest Canopy
Pest Control
Federal and State agencies with a responsibility
to control forest canopy pests
All
Other entities that exceed the annual treatment
area threshold identified here
Decision to treat with adulticide
during a calendar year more than
6,400 acres
Note – If your discharge is from use of an Algicide, Herbicide or Fish Control Chemical in waters of the
Commonwealth then you must obtain a joint approval from PFBC (Pennsylvania Fish and Boat Commission) and
DEP under 25 Pa. Code § 91.38(2).

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Instructions NOI
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Table 2. Discharge Authorization Dates
1
Category
NOI Submittal Deadline
Discharge Authorization Date
Operators not required* to submit an
NOI.
Not applicable.
Immediately*.
Decision-Makers who meet the
criteria requiring submission of an
NOI that they will exceed an annual
treatment area threshold identified in
Table 1 for that year.
At least 30 days before
exceeding an Annual
treatment area threshold.
Immediately* upon beginning to discharge,
until the discharge exceeds an annual
treatment area threshold. The Decision-
Maker is authorized to exceed an annual
treatment area threshold upon DEP‟s
confirmation of the receipt of a complete and
accurate NOI.
Decision-Makers discharging in
response to a declared pest
emergency situation as defined in
Part A II of the General Permit.
No later than 30 days after
commencement of
discharge
1
.
Immediately for activities conducted in
response to a declared pest emergency
situation.
* Operators who use an Algicide, Herbicide or Fish Control Chemical in waters of the Commonwealth must obtain
joint approval from PFBC and DEP under 25 Pa. Code Chapter 91.38(2).
1
In the event that a discharge occurs prior to your submitting an NOI (in the case of a declared pest emergency situation as defined in the
General Permit), you must comply with all other requirements of this permit immediately.

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Who is not eligible to apply for the General Permit?
Discharges of Pesticide are
NOT
covered by the General
Permit when one or more of the following conditions exist:
1. The discharge is to waters classified as HQ or EV under 25 Pa. Code Chapter 93;
2. The discharge is to Impaired Waters with a cause or source related to the pesticide application. Discharges
from pesticide applications to waters of the Commonwealth are not eligible for coverage under this permit if the
water is identified as impaired by that pesticide or its degradates;
3. The discharges are covered by another NPDES permit, or the discharges were included in a permit that within
the last five years has been or is in the process of being denied, terminated, or revoked by DEP (this does not
apply to the routine reissuance of permits every five years);
4. The discharge contains any toxic or hazardous pollutant or any other substance which, because of its quantity,
concentration, or physical, chemical or infectious characteristics, may cause or contribute to an increase in
mortality or morbidity in either an individual or the total population, or pose a substantial present or future hazard
to human health or the environment when discharged into surface waters of the Commonwealth;
5. The discharge, either individually or cumulatively, has the potential to cause significant adverse environmental
impact, including those discharges which would create a public health hazard or nuisance;
6. The discharge is not, or will not be, in compliance with any of the terms or conditions of this General Permit;
7. The applicant has failed and continues to fail to comply or has shown a lack of ability or intention to comply with
a regulation, permit, schedule of compliance or order issued by DEP;
8. The discharge is not, or will not, result in compliance with applicable effluent limitations or water quality
standards;
9. The discharge is determined by DEP to require an individual NPDES permit to ensure compliance with the
federal Clean Water Act, Pennsylvania‟s Clean Streams Law, or rules and regulations promulgated thereto; or
where a change has occurred in the availability of demonstrated technology or practices for the control or
abatement of pollutants applicable to the point source;
10. The discharge is subject to a categorical point source effluent limitation;
11. The discharge is associated with an activity that is subject to an existing NPDES individual or General Permit,
except as allowed herein; or is from a residence where an NPDES permit has been terminated or denied;
12. The discharge would adversely affect a state or federal listed endangered or threatened species or its critical
habitat; and
13. The discharge would interfere with a downstream riparian landowner's reasonable use of surface waters,
property rights, or otherwise cause a private or public nuisance.

3800-PM-BPNPSM0345a Rev. 11/2012
Instructions NOI
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Requirement to Obtain an Individual Permit
DEP may amend, revoke, suspend or terminate previously issued coverage under the General Permit and require
the discharger to obtain an individual NPDES permit for any of the reasons above. In addition, any interested
person may petition DEP to take this action. If the discharge is to a water body affected by an approved TMDL,
DEP will require an individual permit for the discharge if DEP determines that coverage under the General Permit
will not be consistent with the TMDL. DEP may require any discharger authorized to discharge under the General
Permit to apply for an individual NPDES permit, but only if the owner or operator has been notified in writing that an
individual permit application is required. This notice shall include the following:
1. a brief statement of the reasons for this decision;
2. an application form;
3. a statement setting a deadline for the person to file the application; and
4. a statement that on the effective date of the individual NPDES permit, coverage under the General Permit shall
automatically terminate.
The applicant shall submit the individual permit application within 90 days of receipt of the notice. DEP may grant
additional time to submit the application for an individual permit upon written request from the applicant. If the
person fails to submit a permit application within the time allowed, coverage under the General Permit is
automatically terminated at the end of the day specified for individual permit application submittal.
Where to file the NOI.
Three (3) copies of the NOI should be submitted to the appropriate DEP regional office
serving the county in which the facility is located.
When to file the NOI.
Persons seeking coverage under the Pesticide General Permit must submit an
administratively complete and acceptable NOI, along with required documentation, 30 days prior to commencing any
discharge under the General Permit.
NOI Filing Fee.
The required application fee of $250.00, payable to “Commonwealth of Pennsylvania”, must
accompany the application. The check should not be more than 10 days old. The application fee is not required for
federal or state agencies that meet the requirements of 25 Pa. Code 92a.26(i).
DEFINITIONS
To provide the applicant with a better understanding of terminology, DEP has included the following definitions.
Annual Treatment Area Threshold
An area (in acres) or linear distance (in miles) in a calendar year to which a
Decision-Maker is authorizing and/or performing pesticide applications in that area for activities covered under this
permit.
For calculating annual treatment areas for Mosquitoes and Other Flying Insect Pest Control and Forest Canopy Pest
for comparing with any threshold in Table 1, count each pesticide application activity to a treatment area (i.e., that
area where a pesticide application is intended to provide pesticidal benefits within the pest management area) as a
separate area treated. For example, applying pesticides three times a year to the same 3,000 acre site should be
counted as 9,000 acres of treatment area for purposes of determining if such an application exceeds an Annual
Treatment Area Threshold. The treatment area for these two pesticide use patterns is additive over the calendar
year.
Authorization –
Any DEP approval. For example: permits, plans, approvals, licenses, registrations, certifications,
etc. Authorization information is documented and assigned an internal DEP Auth ID# for tracking purposes.
Client (Responsible Party)
A client (also referred to as applicant or permittee) is a person or organization that
requests approval from DEP to perform a regulated activity. Client information is documented and assigned an
internal DEP Client ID# for tracking purposes.
Decision-Maker –
Any entity with control over the decision to perform pesticide applications including the ability to
modify those decisions that result in a discharge to waters of the Commonwealth.
eFACTS (Environment, Facility, Application, Compliance Tracking System)
DEP's electronic application
system to document and maintain client, site data for purposes of authorizing regulated activities and tracking
compliance.

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Instructions NOI
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Site –
A site is a physical location of importance to DEP. A site may include locations where a regulated activity
occurs that has the potential to impact the health and safety of the citizens and/or the natural resources of this
Commonwealth. A site is not solely defined by geographical location (can span several municipalities and even
counties in some cases) but rather by the client/applicant's purpose of doing business. All DEP programs'
involvement at a physical location of importance to DEP is grouped under one “entity” – site. This holistic view of
site will promote an understanding of the interrelationships of facilities to support pollution prevention, multi-media
inspections, a DEP-wide view of compliance, and public understanding and access of information. Site information
is documented and assigned an internal DEP Site ID# for tracking purposes.
CLIENT/OPERATOR INFORMATION
DEP Client ID#.
DEP-wide unique identification number assigned by DEP to the client after client information is
entered into DEP's computer system. This one number identifies the client regardless of the program with which the
client is working. When replying to DEP, inclusion of this number will make it easier to process the request in a
timely manner. If known, enter the Client ID#. Otherwise skip to the next request for information.
Client Type/Code.
Enter the code that represents the type of client acting as the responsible authority for the
permitted activity.
Government
Non-Government
Individual
AUTH
Authority
ASSOR
Association/Organization
INDIV
Individual
CNTY
County
LLC
Ltd. Liability Company
FED
Federal Agency
LLP
Ltd. Liability Partnership
MUNI
Municipality
NPACO
Non-Pennsylvania Corporation
NONPG
Non-PA Govt
OTHER
Other (Non-Govt)
OTHG
Other (Govt)
PACOR
Pennsylvania Corporation
SCHDI
School District
PARTG
Partnership-General
STATE
State Agency
PARTL
Partnership-Limited
SOLEP
Sole Proprietorship
Note:
If two individuals' names are listed as the NOI's clients, the Client Type Code of “Partnership-General” should
be used.
Organization Name or Registered Fictitious Name.
Clients other than individuals must provide the name under
which the activity or business is conducted for which the permit or other authorization will be issued.
Individuals should complete the “Organization Name” only if they conduct their business or activity under a name
other than their own (for example, “Jones Construction Company,” rather than “Mary Jones”).
For partnerships, list the business name of the partnership as it appears on the legal partnership papers.
If the applicant is an individual or partnership, also provide the appropriate information on the individual name lines.
Employer ID#.
Also referred to as “Federal Tax ID#.” The Employer ID# (EIN) aids DEP in identifying the
organization and prevents duplicate data entry from occurring. This information is required.
Dun & Bradstreet ID#.
(Optional) If known, supply the applicant's Dun & Bradstreet Identification Number.
Individual Last Name, First Name, MI, Suffix, Social Security Number.
This information, with the exception of
the SSN, must be provided for applicants who are individuals or partnerships. The SSN aids DEP in identifying the
individual and prevents duplicate data entry, although it is optional. This information is not accessible by the public
or other government agencies.
Additional Individual Last Name, First Name, MI, Suffix, Social Security Number.
This information, with the
exception of the SSN, must be provided for additional applicants who are individuals or partnerships. The SSN aids
DEP in identifying the individual and prevents duplicate data entry, although it is optional. This information is not
accessible by the public or other government agencies.
Mailing Address.
The mailing address of the client identified above (this should
not
include locational data that is
not appropriate for a mail piece). In addition to the street number and name, PO Box#, RR#, Box#, or Highway
Contract# designations, use any appropriate designation and number to further define the mailing address of the
applicant.

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Instructions NOI
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City, State, ZIP+4, Country.
Enter an appropriate city, borough or town designation (do not enter a township
designation in this area). Do
not
use abbreviations for the city name. Use the two-character abbreviation for the
state. Include the four-digit extension to the ZIP code. If other than USA, provide country.
Client Contact Information.
Clients that are organizations must provide the name of the person representing the
client (organization). This client contact must be an employee of the organization and must be located at the mailing
address of the client and able to receive correspondence on behalf of the client. Include the individual's name, title,
daytime phone number and e-mail address. DEP will use this contact information for maintaining client data. This
individual should be a high-level employee such as CEO, VP, Operations Manager, etc. or someone capable of
answering informational questions regarding the organization such as EIN, fictitious name ownership, address data,
related organizations, corporate changes, etc. Project contact information should be entered in the Site Contact
found in the Site Information section.
Person or Organization conducting treatment.
Certified applicators must provide their PA Department of
Agriculture pesticide certification number and business license number, mailing address and contact details.
SITE INFORMATION
DEP Site ID#.
DEP-wide unique identification number assigned to the site after site information is entered into
DEP's computer system. This one number identifies the site regardless of the program with which the applicant is
working. When replying to DEP, inclusion of this number will make it easier to process the NOI in a timely manner.
If known, enter the Site ID#. Otherwise skip to the next request for information.
Site Name.
The name of the site at the specific physical location. Do not use abbreviations or acronyms.
Estimated Number of Employees to be Present at Site.
To assist with future Pollution Prevention and
Compliance Assistance initiatives, please include the estimated number of employees to be present at the site once
it is active.
Description of Site.
Provide a written description of the proposed treatment site (e.g., water, forest, etc.).
County, Municipality, State.
Indicate the county and municipality in which the site is located. Check the
appropriate box to identify the type of municipality.
Site Location.
Provide the physical address of the location where the permitted activities will occur. No PO Box
Numbers will be accepted for site location information. Provide the City (or Municipality), State and the ZIP+4. If you
have multiple sites, please check the box and attach details along with your NOI.
Detailed Written Directions to Site.
When providing written directions, do not use PO Box address data. Include
landmarks and approximate distances from the nearest highway.
Site Contact Information.
Provide the name of the person having overall responsibility for environmental matters
at the site. Include the individual's name, title, firm, mailing address, daytime phone number and e-mail address
(optional).
NAICS Codes.
Clients applying for an authorization from DEP need to provide the appropriate North American
Industry Classification System (NAICS) code(s) at the Sector level (at a minimum). The list of NAICS Sector and
Subsector level codes can be found by referencing „GIF NAICS Codes‟. This document can be found on the DEP
website with this GIF package or by contacting a DEP office identified at the end of this instructions document.
Site-to-Client Relationship.
Enter the relationship code that best describes how the client is related to the activity
or operation at the site for which the permit is being sought.
Code
Type
Code
Type
OWN
Owner
LESOP
Lessee/Operator
AGENT
Agent for the Owner or Operator
CONTR
Contractor for the Owner or Operator
OWNOP
Owner/Operator
OPR
Operator
LESSE
Lessee
OTHER
Other (Explain)

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Instructions NOI
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TREATMENT AREA INFORMATION
Existing Permits.
List all permits that have been issued or applied for on behalf of this Operator by DEP. Include
any NPDES and WQM permits, Earth Disturbance permits and any other environmental quality permits. Provide the
issued permit number and the date issued or applied for.
If Treatment Is To a Water Body
Confirm whether or not the water body is stocked by the Fish and Boat Commission.
Does the water body overflow at least part of the year? If overflow occurs, indicate the time of year in the space
provided. This will help us determine the effectiveness of the pesticide proposed in your water body, as well as
potential impact on aquatic life downstream. Name the receiving stream if overflow ever occurs. If the stream is
unnamed, indicate “Unnamed tributary to
Creek” (next stream with a name).
This will help DEP
determine the characteristics of the aquatic community in the receiving waters.
Treatment Area Location & Drainage Map.
Attach the USGS topographical map showing the discharge area and
location. A good quality 8½ x 11 inch copy of the portion of the topographic map locations is acceptable. Provide
the name of the 1:24,000 scale USGS 7.5-minute series quadrangle map. Submit a copy of the map(s) with the
NOI. Provide the total surface area in acres. This is a critical measurement that has a direct bearing on the amount
of pesticide to properly use. Note: 43,560 sq. feet = 1 acre. If the treatment area is a pond, determine the shape of
the pond and use one of the following area formulas: Area of circle = 3.14 (radius)
2
, Area of rectangle = Length x
Width, Area of triangle = 0.5 x base x height (base is usually the distance across the dam, height is typically the
pond length).
Latitude/Longitude.
Latitude and longitude measures aid in providing the physical location of the discharge point.
Indicate appropriate degrees, minutes and seconds for the project.
Additional Locational Data Information.
This information is being requested in order to determine the method,
accuracy and description of the latitude and longitude information that is being provided with the application. If
known, please provide this information for the locational data. The list of locational data codes and descriptions can
be found electronically on DEP's website under “Permit and Authorization Packages.”
CHAPTER 93 CLASSIFICATION, IMPAIRMENT AND TMDL STATUS
Provide
ALL
requested information in this area. Provide the receiving water classification listed in Chapter 93
regulations for the proposed application activities discharging to waters of the Commonwealth. Information on
receiving water classifications can be obtained from 25 Pa. Code Chapter 93 of DEP‟s regulations available
electronically at
http://www.pacode.com
or by calling or writing to the appropriate DEP regional office. Document
the “impairment status” of the receiving water by listing either “Attaining Water Quality Standards” or “Impaired”.
This information can be acquired using DEP‟s “eMap” online system or by reviewing the latest Integrated Water
Quality Monitoring and Assessment Report on DEP‟s website. In addition, document whether a TMDL has been
approved for the receiving water, no TMDL has been developed, or not applicable (if the water is not impaired).
This
information
can
be
acquired
through
DEP‟s
website
(see
http://www.dep.state.pa.us/watermanagement_apps/tmdl/
).
Once the NOI has been submitted, the discharger may assume that the classification of the receiving waters will not
change for the length of the permit term unless notified by DEP to the contrary. If the existing use of receiving water
is determined to be HQ or EV, the applicant will be required to submit an individual NPDES permit application.

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PESTICIDES USE PATTERNS
Use Patterns and Location.
Operators should provide a map
2
with the location(s) of pesticide applications and a
description of the location(s) of pesticide applications for all four pesticide use patterns.
Information Regarding Receiving Waters.
Indicate whether or not pesticide applications will be over or near all
waters identified in the map by selecting one of three options.
The Pennsylvania Natural Diversity Inventory (check one):
Confirm whether or not coverage requested will
overlap with the distribution map locations of any Species or Habitat by selecting one of two options. In case of
overlap, inform whether or not you have consulted with the Department of Conservation and Natural Resources, the
Pennsylvania Game Commission, the Pennsylvania Fish and Boat Commission, and the U.S. Fish and Wildlife
Service under PNDI (The Pennsylvania Natural Diversity Inventory). Also, in case of overlap with the distribution of
any Species or Habitat. Please search and list all Species or Habitat identified within the area for which coverage is
requested
(http://www.naturalheritage.state.pa.us/Species.aspx)
for abbreviation details select Rank and Status
(http://www.naturalheritage.state.pa.us/RankStatusDef.aspx).
PROPOSED TREATMENT DOSAGE INFORMATION
(for multiple treatment areas, a GIS file can be submitted electronically)
For each pesticide proposed for use, provide the following information. Pesticides must, by federal law, be used as
specified in their product label.
Pesticide name.
Record the name of the product to be utilized (e.g., for “Reward”, do not list the active ingredient,
diquat dibromide). The product proposed for use must be registered with the U.S. EPA, labeled for aquatic use and
listed with the PA Department of Agriculture. Product labels containing dosage information must be attached with
the NOI.
Manufacturer.
The company that produces the pesticide proposed for use.
Registration Number.
The U.S. EPA registration number for the product proposed for use.
Treatment area.
Area to be treated, in acres or linear miles (indicate units with value).
Dose.
The proposed dose (dosage rate) for the product. Also indicate the units associated with the dosage rate.
The dose listed must be within the dose range on the product label. Dose for products labeled to treat area is
usually pounds or gallons per surface acre. Dose for products used to treat water volume is usually expressed as
pounds or gallons per acre-foot. One acre-foot is one acre of water one foot deep. The pond or pond section
volume is calculated by multiplying the area in acres times the average depth in feet.
Amount of pesticides/biocides used for treatment.
Amount of pesticide to be used for a single treatment.
Number of treatments proposed for the year.
Target.
Target plant(s) and/or species to be controlled by the pesticide. List all you expect to be controlled by the
product.
Treatment date.
Proposed treatment dates. This can be a range of time in which multiple treatments are to be
made.
Additional information.
Additional information or comments can be provided for the reviewer. Examples are
“Higher algaecide dose is to control Pithophora, resistant algae” or “Overflow will be stopped for 48 hours following
treatment”.
2
Attach an 8.5” x 11” photocopy of a topographical map to show the location of the water-body and/or the area to be treated. This map can be
printed from a website such as
http://itouchmap.com/latlong.html
or can be a photocopy of a 7.5 minute USGS topographical quadrangle. The
application area should be clearly identified. Provide the name of the 1:24,000 scale USGS 7.5-minute series quadrangle map which shows
the application area. This information will be used to compare the proximity of the treated body of water to receiving streams, other permitted
treatment areas and other water users such as public water supplies.

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NOTIFICATION
If potential users of treated water may possibly be affected by treatment, notification at least 24 hours in advance is
required. Recognize that products applied to water can drift to non-target areas or be discharged downstream.
Indicate whether or not notification has occurred by the time the application is submitted or will occur prior to
treatment. Indicate if you are aware of any objections to treatment from potential users of treated water. If you are
aware of objections, describe them in the space provided or on a page attached to the application.
COMPLIANCE HISTORY REVIEW
Check the appropriate box to indicate if the facility owner or operator is in violation of any DEP regulation, permit,
order or schedule of compliance at this or any other facility. If the answer is “NO,” no further information is needed
in this area. If “YES,” list each permit, order or schedule of compliance and provide compliance status of the
permitted facility or operation. If needed, use additional sheets to provide information on ALL permits.
CERTIFICATION
The applicant must certify that the information contained in the NOI is true, accurate and complete and agree to
abide by the terms and conditions of the General Permit. In addition, the responsible official's signature also
certifies that the facility is eligible for coverage under the General Permit and ensures that water quality standards
and effluent limits are attained.
The NOI shall be signed as follows:
For individually owned operations
- the owner of the facility must sign the NOI.
For a Corporation
- by a responsible corporate officer. For purposes of this section, a responsible corporate officer
means a principal executive officer of at least the level of vice president or an authorized representative, if the
representative is responsible for the overall operation of the facility from which the discharge described in the NOI
originates.
For a Partnership or Sole Proprietorship
- by a general partner or the proprietor, respectively.
For a Municipality, State, Federal or other public agency
- by either a principal executive officer, ranking elected
official or other authorized employee. For purposes of this NOI, a principal executive officer of a federal agency
includes:
a. The chief executive officer of the agency, or
b. A senior executive officer having responsibility for the overall operations of a principal geographic unit of the
agency.

3800-PM-BPNPSM0345a Rev. 11/2012
Instructions NOI
- 12 -
PESTICIDE DISCHARGE MANAGEMENT PLAN
A Pesticide Discharge Management Plan (PDMP) is required of any Decision-Maker who must submit an NOI
(Table 1) and is either a Large Entity (defined in Part A II of the General Permit) or will otherwise exceed the Annual
Treatment Area Thresholds (Table 1). The PDMP will require input from the pesticide applicator. The PDMP must
be consistent with the deadlines identified in Table 3 below. For detailed contents of the PDMP see Appendix D of
the General Permit.
Table 3. Pesticide Discharge Management Plan Deadlines
Category
PDMP Deadline
Operators not required to submit an NOI.
Not applicable
Operators who know or should have reasonably
known, prior to commencement of discharge, that
they will exceed an Annual Treatment Area
Threshold identified in Table 1 for that year.
Prior to first pesticide application
covered under this permit.
Operators who do not know or would reasonably
not know until after commencement of discharge,
that they will exceed an Annual Treatment Area
Threshold identified in Table 1 for that year.
Prior to exceeding an Annual
Treatment Area Threshold.
Operators commencing discharge in response to
a declared pest emergency situation as defined in
Part A II of the General Permit that will cause the
operator to exceed an Annual Treatment Area
Threshold.
No later than 90 days after
responding to declared pest
emergency situation.
APPLICANT
'
S CHECKLIST
To ensure the NOI is complete, DEP has provided a checklist (3800-PM-BPNPSM0345c) of what must be attached
to the NOI. This checklist is to be returned with the completed NOI.
DEP OFFICES
A listing of DEP regional offices can be found on DEP's website
(
www.dep.state.pa.us
, select Regional Resources).

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