Fill out this form if you believe you do not require a NJPDES Discharge Permit for a stormwater discharge. Return this form
completed, dated and signed, to the
UBureau of Nonpoint Pollution ControlU at the above address.
1. Facility Information:
Facility Name: ____________________________________________________________________________________
County:__________________________________________SIC Code: _______________________________________
Contact Person: __________________________________Tele. #: ________________________________________
2. Check the appropriate box(es) which provide(s) the reason(s) that you believe that you are not
required to obtain (for the facility identified above) a NJPDES Permit for a stormwater discharge:
(i) ALL the stormwater from the site is discharged to a combined sewer (one that carries sanitary wastewater
and stormwater to municipal treatment plant). You can not claim this exemption if any part of the site where
industrial activity occurs is unpaved. The Combined Sewer Certification on the back of this form must be
completed and signed, or other supporting documentation submitted.
Our business or agency has an existing NJPDES-DSW permit authorizing the discharge of all of this facility’s
stormwater to surface waters. NJPDES No. NJ _____________________
Our business or agency has an existing NJPDES-DGW permit authorizing the discharge of all of this facility’s
stormwater to groundwater. NJPDES No. NJ _______________________
Permanent No Exposure – ALL industrial materials are stored and/or ALL industrial activities are performed
(with limited exceptions) inside a permanent building or permanent structure that is anchored to a permanent
foundation and that is completely roofed and walled. The attached Permanent No Exposure Certification Form
must be completed, signed and submitted with this Nonapplicability Form. A Signed Permanent No Exposure
Certification must be submitted to the Department every 5 years.
All industrial activity has ceased and no "Significant Material" remains exposed to stormwater.
Our business or agency is in Category viii (SIC Code 40 – 45 (except 4221-4225), and 5171) and is not
involved in vehicle maintenance (including vehicle rehabilitation, mechanical repairs, painting, fueling and
lubrication), equipment cleaning operations, or airport deicing operations.
Other: (Attach printed or typed explanation).
*SUBJECT TO VERIFICATION BY DEPARTMENT SITE INSPECTION*
3. Who Must Sign
A Responsible Official is defined in N.J.A.C. 7:14A – 4.9 as follows:
For a corporation
U: A president, secretary, treasurer, or vice-president of the corporation in charge of a principal business
function, or any other person who performs similar policy or decision making functions for the corporation; or the manager
of one or more manufacturing, production, or operating facilities, provided:
(1) The manager is authorized to make management decisions that govern the operation of the regulated facility, including
having the explicit or implicit duty of recommending major capital investment, initiating and directing comprehensive
measures to assure long term compliance with environmental laws and regulations, and ensuring that the necessary
systems are established or actions taken to gather complete and accurate information for permit application requirements;
(2) The authority to sign documents has been assigned or delegated to the manager in accordance with corporate
New Jersey Department of Environmental Protection
Division of Water Quality
Bureau of Nonpoint Pollution Control
P.O. Box 420 - 401 E. State. St.
Trenton, New Jersey 08625-0420
NONAPPLICABILITY FORM (NAF)
1 of 6 03/11
Mail Code 401-02B
Elizabeth I. Kellogg Building
40 West Jersey Street, Elizabeth