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STATEWIDE SANITARY SEWER SYSTEMS GENERAL ORDER 2022-0103-DWQ <br />3. Regulatory Coverage Termination Certification <br />I certify under penalty of perjury under the laws of the State of California that to the best of <br />my knowledge: 1) the sanitary sewer system 1 officially represent is not required to be <br />regulated under the Statewide Waste Discharge Requirements for Sanitary Sewer Systems <br />Order 2022-XXXX-DWQ, and 2) the information submitted in this Notice of Termination is <br />true, accurate and complete. 1 am aware that there are significant penalties for submitting <br />false information, including the possibility of fine or imprisonment. Additionally, I understand <br />that the submittal of this Notice of Termination does not release sanitary sewer system <br />agencies from liability for any violations of the Clean Water Act. <br />Print Name: <br />Title: <br />Signature: Date: <br />For State Water Board Use Only <br />❑ Approved for Termination <br />Deputy Director of Water Quality Signature: <br />Date: <br />❑ Denied and Returned to Enrollee <br />Notice of Termination Effective Date: <br />ATTACHMENT C — NOTICE OF TERMINATION December 6, 2022 <br />C - 2 <br />