ATTACHMENT L
NOTICE OF TERMINATION FORM
CALIFORNIA REGIONAL WATER QUALITY CONTROL BOARD
SAN FRANCISCO BAY REGION
For the General Waste Discharge Requirements for
Discharges of Winery Waste to Land Within the San Francisco Bay Region
Order No. R2-2017-XXXX
In order for the San Francisco Bay Regional Water Quality Control Board (Regional Water Board) to terminate your coverage under the General Waste Discharge Requirements for
Discharges of Winery Waste to Land (Order), complete and submit the enclosed Notice of Termination form (NOT) to the Regional Water Board.
The Discharger may request termination of permit coverage by submitting this NOT to the Regional Water Board when one or more of the following conditions are met:
1. The facility is closed and all closure, moving, and clean-up activities are complete.
2. The facility was transferred to a new owner.
3. The facility’s discharge is regulated by individual waste discharge requirements.
4. The facility is no longer discharging to land.
Submittal of a NOT does not guarantee termination. If your NOT is denied, you will be required to continue complying with the requirements of the Order and all outstanding invoice(s) are due. You will be notified of your NOT status by the Regional Water Board. Approval of your Notice of Termination does not relieve you from paying any applicable outstanding invoices.
NOTICE OF TERMINATION
Of Coverage Under the General Waste Discharge Requirements for
Discharges of Winery Waste to Land Order No. R2-2017-XXXX
Submission of this Notice of Termination constitutes notice that the owner (and his/her agent) of the Facility identified on this form is no longer authorized to discharge wastewater to land associated with winery process activities by Order No. R2-2017-XXXX.
A. Owner
1. Owner Name:2. Mailing Address:
3. City: / 4. State: / 5. Zip:
6. Phone Number: / 7. Fax: / 8. Email:
9. Contact Person: / 10. Title:
B. Facility
1. Facility Name:2. Location Address:
3. City: / 4. State: / 5. Zip:
6. County / 7. Phone Number: / 8. Email:
9. Contact Person: / 10. Title:
C. Basis of Termination
1. Closed Facility: The Facility is closed and all closure, moving, and clean-up activities are complete.
Date of Closure: ______
2. Regulated by Another Permit: Discharge of winery process wastewater and solids associated with wine processing activities is specifically regulated by another general or individual Waste Discharge Requirements.
Permit No.: ______Date Coverage Began: ______
3. New Owner:
a. Date facility/site was transferred to new owner: ______
b. Have you notified the new owner of the Waste Discharge Requirements for the Discharge of Winery Waste to Land: Yes No
c. New Owner Information
1. New Owner Name:2. Mailing Address:
3. City: / 4. State: / 5. Zip:
6. Phone Number: / 7. Fax: / 8. Email:
9. Contact Person: / 10. Title:
4. Facility No Longer Discharges Any Wastewater to Land:
Explain the basis/reasons why the Facility is no longer discharging to land, including but not limited to, the date the discharge to land ceased and a description of the new wastewater management system. Include photographs depicting the decommissioning of the previously permitted wastewater discharge system and the new wastewater management system.
REGIONAL WATER BOARD CONTACT INFORMATION
The completed NOT can be submitted to the Regional Water Board via a) mail or b) as electronic files in PDF and in spreadsheet (when applicable) format via email.
a) Regional Water Board office location and mailing address:
California Regional Water Quality Control Board, San Francisco Bay Region
Attention: Watershed Management Division, Wineries
1515 Clay Street, Suite 1400
Oakland, California 94612-1482
b) Electronic Reporting Format. Electronic files can submitted to the Regional Water Board via the centralized email address and to the Regional Water Board staff listed below.
Email:
Send a copy of the email notification to the following Regional Water Board staff:
Melissa Gunter:
Blair Allen:
If you have questions or need further assistance with the NOT, call the Regional Water Board and ask for a staff person in the Watershed Management Division who works with wineries.
Regional Water Board main office telephone number: (510) 622-2300
Regional Water Board main web site: http://waterboards.ca.gov/sanfranciscobay/
General Waste Discharge Requirements for Discharges of Winery Waste to Land website:
http://www.waterboards.ca.gov/sanfranciscobay/water_issues/programs/on_site_wastewater_treatment_systems.shtml
Order No. R2-2017-XXXX Attachment L p. 4 of 4