Follow the steps to successfully complete the form.

1. Use the ‘Get Form’ button to access the form and open it in your document editor.
2. In Section I, enter the required information for the existing WPDES permittee responsible for the pollutant discharge. This includes their first and last name, organization, mailing address, city, state, email, and phone number.
3. Proceed to Section II to provide the existing project or facility site information. Fill in the project or facility site name, WPDES permit number, ZIP code, alternative phone number, and the Facility Identification (FID) number if known. Also, describe the location with details such as GPS coordinates.
4. In Section III, complete the information for the proposed WPDES permittee. Repeat the similar steps as in Section I, including their name, organization, and contact details, and describe any facility changes if relevant.
5. Finalizing your submission requires completing Section IV, where both the transferor and transferee must certify the accuracy of the information provided. Ensure each party signs the form, dates it, and includes their printed name and title.
6. Once the form is completed and signed, review all the information for accuracy. After confirming everything is correct, you can save changes, download, print, or share the form as necessary.

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