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STATEWIDE SANITARY SEWER SYSTEMS GENERAL ORDER 2022-0103-DWQ <br />ATTACHMENT C - NOTICE OF TERMINATION <br />1. Enrollee Information <br />Enrollee Name: <br />WDID No: <br />Legally Responsible Official Requesting Termination of Coverage: <br />First and Last Name: <br />Title: <br />Phone: <br />Email: <br />Mailing Address: <br />City, State, Zip: <br />County: <br />Sanitary Sewer System Name(s) or Unique Identifier(s): <br />Regional Water Quality Control Board(s): <br />Signature and Date: <br />2. Basis of Termination <br />Explanation of termination, including subsequent regulatory coverage and subsequent <br />owner/operator of enrolled sanitary sewer system, as applicable: <br />ATTACHMENT C — NOTICE OF TERMINATION December 6, 2022 <br />C - 1 <br />