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Recertification Notice of Intent (NOI) Industrial Stormwater General Permit ARROOOOOO You must complete, certify, and sign this Recertification Notice of Intent (NOI) form and return it to the Department in order to continue permit coverage under the General Permit ARROOOOOO. You must submit this form no later June 30. 2014. Please keep a copy ofthis form for your records once completed and signed.
Permit Tracking Number: ARR000933 AFIN: 32-00543 Permittee Name: Hatfield Ready Mix
If any changes or additions need to be made to the information shown below, please update the new information in the corrections section below and!or attach documentation.
Current Information in ADEQ's Database Corrections! Additions, If Needed Facility Name: Hatfield Ready Mix Facility Address: 100 Lesley Hollow Rd Batesville, 72501 Industrial Sector: E2/J! Contact Person: Michael Hatfield Responsible Official: Michael Hatfield Responsible Official Email: [email protected] Cognizant Official: Michael Hatfield Cognizant Official Email: [email protected]
Are there any changes to the outfalls at this facility? Yes* or ~ *Ifyes, please attach a site map and the coordinates ofall outfalls at the facility.
Have you submitted 2013 Annual Report and DMRs, due by January 31, 2014? Yes or C* **lfNo, please submit the Annual Report and DYlRs with this recertification. The renewal £ot be processed until DMRs and an Annual Report are received by the Department.
Are the mailing and invoice addresses the same? Yes or No*** ***If"No," please provide invoice address:
Additional Comments: 04.++~11 #= I IS now /It (10 dj~et..M..lje Pt,,\/). E'{C.J~tJA~M (OA1e/t'I--ed _~~c~~~~~a~b~13~.~~~e~I~A~a~n~~'h~p~r~o~c~~rs~S_o~~_·~q~e~f~t~h~9~·~~~.~O~C~6=·~~~~_~~i~t~A;7~'*lh N~ o~h~ge hAS c:l.Cuvrecl SIr)e'!. !pt..,\\l) h~5 veeV' e,fdA"Cjt'cj. "I certity under penalty of law that this document and all attachments were prepared under my direetion 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 direetly responsible for gathering the information, the information submitted is, to the best of my knowledge and beliet: true, accurate, and eomplete. I am aware that there are significant penalties tor submitting false information, including the possibility of fine and imprisonment for knowing violations."
I certify that I have read and will comply with all the requirements of the Industrial Stormwater General Permit ARROOOOOO. Responsible Official Name: fY\ Itha.~ \ H~TE Ie Lf) Responsible ~ffi~ial Title.: m~~A':A. ~L.ioNe Responsible OffiCial Signature: -L'M--'---7-=-'="ii;::..:-----,-,-.r.r-=.:'-IP""------ Date: - 2. - I
Return the NOt form to the address below or send it electronically to: water.pcrmit.application,a~adeg.state.ar.us Water Division, General Permits Section Arkansas Department of Environmental Quality 5301 Northshore Drive North Little Rock, AR 72118-5317