under penalty of law that this document and all attachments were prepared by me, or under my direction or supervision. The submitted information 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. As specified in Tennessee Code Annotated Section 39-16-702(a)(4), this declaration is made under penalty of perjury. Permittee name (print or type).
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How to fill out the TN CN-1175 online
This guide provides a comprehensive and user-friendly approach to completing the TN CN-1175 form online. Understanding each section of this form is crucial for ensuring the proper termination of coverage from the general NPDES permit for stormwater discharges from construction activities.
Follow the steps to complete the TN CN-1175 online.
- Click the ‘Get Form’ button to obtain the form and open it in the editor.
- Enter the site or project name in the designated field on the form.
- Fill in the NPDES tracking number, which is typically assigned to your project.
- Provide the street address or location of the project, ensuring accuracy.
- Indicate the counties where the project is located.
- Enter the name of the person or entity requesting the termination of coverage.
- Complete the field for the permittee contact person's name and title or position.
- Fill in the mailing address for the permittee, including city, state, and zip code.
- Provide a contact phone number and email address for further communication.
- Check the appropriate reason(s) for termination of permit coverage by selecting the relevant options.
- Review the certification and signature section, ensuring it is signed by an authorized individual, such as the president or vice-president.
- Check the date field to indicate when the form is being submitted.
- Finally, save changes, and download, print, or share the form as required.
Complete your TN CN-1175 form online today to ensure compliance and proper documentation.
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