STATE OF COLORADO

DEPARTMENT OF TRANSPORTATION

4201 East Arkansas Avenue

Denver, Colorado 80222
(303) 757-9011

Colorado Department of Public Health & Environment

Water Quality Control Division
WQCD-P-B2
4300 Cherry Creek Drive South
Denver, Colorado 80246-1530

Date :
RE : Notice of Transfer and Acceptance of Terms and Conditions of a CDPS
General Stormwater Discharge Permit Certification Associated With Construction
Activities
RE : CDOT Project Number ___________________________________
CDOT Region ___________
Colorado Discharge Permit Certification No. CO_____________________
The purpose of this letter is to transfer the responsibilities for Terms and Conditions of the CDPS
Stormwater Discharge Permit Associated with Construction Activities from the Resident
Engineer in charge of the construction project to the Maintenance Superintendent taking
responsibility for post construction permit requirements as prescribed in the March xx, 2006
Construction Activity Stormwater Discharge Permit Policy Memo 27 from CDOT Chief
Engineer, Craig Siracusa.
I hereby accept transfer of the CDPS Certification named above. I have reviewed the terms and
conditions of this permit and the Stormwater Management Plan and accept full responsibility,
coverage and liability. This transfer will be effective on:________________________.
Name (printed)_________________________________________________________________
Title
Signature of Maintenance Superintendent ____________________________________________
Date Signed
As previous permittee, I hereby agree to the transfer of the above referenced permit and
certification and all responsibilities thereof.
Name (printed)_________________________________________________________________

Title
Signature of Resident Engineer ____________________________________________________
Date Signed