3150-FM-BWEW0271 102015 COMMONWEALTH OF PENNSYLVANIA-2026

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The document is a Co-Permittee Liability Release Form used in Pennsylvania for individuals or organizations covered under specific environmental permits related to stormwater discharges and earth disturbance activities. It allows a co-permittee to withdraw from their responsibilities, acknowledging that remaining permittees will still be liable for compliance with permit conditions. The form includes sections for permit information, acknowledgment of responsibilities, certification of withdrawal, and notary acknowledgment.

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Click ‘Get Form’ to open the 3150-FM-BWEW0271 in our editor.
Begin by entering the Permit Number in the designated field at the top of the form. This is crucial for identifying your specific permit.
Fill out the Earth Disturbance Site Location section, including Facility/Development Name, Address, Municipality, Latitude, Longitude, and U.S.G.S. Quad Map Name.
In the Permittee Acknowledgement section, provide your Organization/Individual Name, Address, City, State, Zip Code, and Telephone Number. Ensure that you acknowledge the responsibilities of co-permittees.
Complete the Co-Permittee Certification by certifying that you are no longer an operator of the construction activity. Fill in your details and sign where indicated.
Finally, ensure that a Notary Public acknowledges your signature in the Acknowledgement section before submitting the form.

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