The Ohio EPA 4496 form serves as the Co-Permittee Notice of Intent for Coverage Under Ohio's Storm Water Construction General Permit. By submitting this form, an applicant notifies the Ohio Environmental Protection Agency of their intention to be authorized under the National Pollutant Discharge Elimination System (NPDES) general permit, which regulates storm water discharges associated with construction activities. Compliance with the permit's terms and conditions becomes mandatory for those who obtain permittee status.
When it comes to managing stormwater associated with construction activities in Ohio, the Ohio EPA 4496 form plays a crucial role. This form, known as the Co-Permittee Notice of Intent for Coverage Under Ohio EPA Storm Water Construction General Permit, serves as a formal notification to the Ohio Environmental Protection Agency (EPA) that a party intends to seek authorization under the National Pollutant Discharge Elimination System (NPDES) general permit. By submitting this form, applicants are stepping into a responsibility that requires adherence to specific terms and conditions set forth by the permit. It's important to note that the form must be filled out completely and accurately; any omissions can lead to delays or complications in the approval process. Additionally, applicants should read the accompanying instructions thoroughly before starting, as using correction fluid or submitting the form via fax is strictly prohibited. While there is no fee to file this form, the implications of providing false information are serious, including potential fines and imprisonment. The form requires detailed information about the applicant and the facility or site location, ensuring that all relevant parties are accounted for. Completing this form is not just a bureaucratic step; it’s a commitment to responsible environmental stewardship.
Co-Permittee Notice of Intent for Coverage Under
Ohio EPA Storm Water Construction General Permit
Submission of this NOI constitutes notice that the party identified in Section I of this form intends to be authorized by Ohio’s NPDES general permit for storm water associated with construction activity. Becoming a permittee obligates a discharger to comply with the terms and conditions of the permit. NOTE: All necessary information must be provided on this form. Read the accompanying instructions carefully before completing the form. Do not use correction fluid on this form. Forms transmitted by fax will not accepted. There is no fee associated with submitting this form.
I.Applicant Information/Mailing Address
Company (Applicant) Name:
Mailing (Applicant) Address:
__________________________________________________________________________________
City:
State:
Zip Code:
Contact Person:
Phone:
Fax:
Contact E-Mail Address:
II. Facility/Site Location Information
Existing Ohio EPA Facility Permit Number: ______________________________
Initial Permittee Name:
Facility/Site Name:
Township(s):
County(ies):
Ohio
Facility Contact Person:
Facility Contact E-Mail Address:
III. Certification
I certify under penalty of law that this document and all attachments were prepared under my direction 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 persons directly 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.
Applicant Name:
Title:
Applicant Signature:
Date:
EPA 4496 (Rev. 2/10)
CLICK TO CLEAR ALL ENTERED INFORMATION
Partial Disability Ohio - Alternative documentation like W-2s or 1099s can be submitted if detailed earnings reports are unavailable, aiding in the calculation of compensation rates.
In order to ensure a smooth rental experience, both parties should familiarize themselves with the Arizona Room Rental Agreement, a legal document that serves to outline essential terms and conditions for renting a room in Arizona. For further guidance, resources can be found at Arizona PDFs, which provide valuable templates to help landlords and tenants understand their rights and responsibilities.
Ohio Irp - A section for proposed estimated mileage provides guidance for applicants unsure of their jurisdictional mileage.