Storm Water Pollution Prevention Plan Request to Reduce Frequency of Construction Site Stormwater Inspections
Section I. General Information
Name of Project	Project Location	Owner/Operator	CGP Authorization No.	Project Start Date
Section II. Request to Reduce Inspection Frequency
In accordance with the Arizona Pollutant Discharge Elimination System (AZPDES) and/or the National Pollutant Discharge Elimination System (NPDES) General Permits for Discharge from Construction Activities to Waters of the United States, a reduced inspection schedule can be requested for approval. This request shall be submitted by the Erosion Control Coordinator (ECC) to the ADOT Resident Engineer (RE) and shall receive signed approval prior to the commencement of the reduced inspection schedule. The approved form shall be kept on record in the SWPPP.
[Select applicable agency-specific text regarding inspection frequency. If both ADEQ and EPA Construction General Permits (CGPs) are applicable to your project, then select whichever is the more stringent language option from the drop-down list to satisfy requirements for both CGPs.]
Section IV.A Certification and Signature by ECC
“I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted 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 for knowing violations.”
Signature of ECC:	Date:
Printed Name:	Title:
Affiliation:	Address:
Email Address:	Office:	Cell:

Section IV.B Certification and Signature by ADOT Resident Engineer
Check one of the following:	The request for a change in inspection frequency has been approved as per the reasoning stated in Section II above. The request for a change in inspection frequency has been denied due to the following reason(s):
“I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted 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 for knowing violations.”
Signature of ADOT Resident Engineer:	Date:
Printed Name:	Title:
ADOT Office:	Address:
Email Address:	Office:	Cell: