ESBD_361754_1717708206843_Bid No. 24-28 Project Manual FY 2021 -2022 Sanitary Sewer Replacements_Part2.pdf

□ Site Address/Location. Do not use a rural route or post office box.

GENERAL CHARACTERISTICS

□ Indian Country Lands –the facility is not on Indian Country Lands.

□ Construction activity related to facility associated to oil, gas, or geothermal resources

□ Primary SIC Code that best describes the construction activity being conducted at the site.

www.osha.gov/oshstats/sicser.html

□ Estimated starting and ending dates of the project.

□ Confirmation of concrete truck washout.

□ Acres disturbed is provided and qualifies for coverage through a NOI.

□ Common plan of development or sale.

□ Receiving water body or water bodies.

□ Segment number or numbers.

□ MS4 operator.

□ Edwards Aquifer rule.

CERTIFICATION

□ Certification statements have been checked indicating Yes.

□ Signature meets 30 Texas Administrative Code (TAC) §305.44 and is original.

TCEQ-20022 Checklist (03/06/2018) Page 2

TCEQ 20022 (3/6/2018)

Instructions for Notice of Intent for TPDES General Permit TXR150000

Where to Send the Notice of Intent (NOI):

GENERAL INFORMATION

Instructions for Notice of Intent (NOI) for Stormwater Discharges Associated with Construction

Activity under TPDES General Permit(TXR150000)

By Regular Mail:

TCEQ

Stormwater Processing Center (MC228) P.O. Box 13087 Austin, Texas 78711-3087

By Overnight or Express Mail:

TCEQ

Stormwater Processing Center (MC228) 12100 Park 35 Circle Austin, TX

Application Fee:

The application fee of $325 is required to be paid at the time the NOI is submitted. Failure to submit payment at the time the application is filed will cause delays in acknowledgment or denial of coverage under the general permit. Payment of the fee may be made by check or money order, payable to TCEQ, or through EPAY (electronic payment through the web).

Mailed Payments:

Use the attached General Permit Payment Submittal Form. The application fee is submitted to a different address than the NOI. Read the General Permit Payment Submittal Form for further instructions, including the address to send the payment.

ePAY Electronic Payment: http://www.tceq.texas.gov/epay

When making the payment you must select Water Quality, and then select the fee category “General Permit Construction Storm Water Discharge NOI Application”. You must include a copy of the payment voucher with your NOI. Your NOI will not be considered complete without the payment voucher.

TCEQ Contact List:

Application – status and form questions: 512-239-3700, swpermit@tceq.texas.gov Technical questions: 512-239-4671, swgp@tceq.texas.gov Environmental Law Division: 512-239-0600 Records Management - obtain copies of forms: 512-239-0900 Reports from databases (as available): 512-239-DATA (3282) Cashier’s office: 512-239-0357 or 512-239-0187

Notice of Intent Process:

When your NOI is received by the program, the form will be processed as follows:

Administrative Review: Each item on the form will be reviewed for a complete response. In addition, the operator’s legal name must be verified with Texas Secretary of State as valid and active (if applicable). The address(es) on the form must be verified with the US Postal service as receiving regular mail delivery. Do not give an overnight/express mailing address.

Notice of Deficiency: If an item is incomplete or not verifiable as indicated above, a notice of deficiency (NOD) will be mailed to the operator. The operator will have 30 days to respond to the NOD. The response will be reviewed for completeness.

Acknowledgment of Coverage: An Acknowledgment Certificate will be mailed to the operator. This certificate acknowledges coverage under the general permit.

or

Denial of Coverage: If the operator fails to respond to the NOD or the response is inadequate, coverage under the general permit may be denied. If coverage is denied, the operator will be notified.

General Permit (Your Permit)

For NOIs submitted electronically through ePermits, provisional coverage under the general permit begins immediately following confirmation of receipt of the NOI form by the TCEQ.

For paper NOIs, provisional coverage under the general permit begins 7 days after a completed NOI is postmarked for delivery to the TCEQ.

You should have a copy of your general permit when submitting your application. You may view and print your permit for which you are seeking coverage, on the TCEQ web site http://www.tceq.texas.gov.

Search using keyword TXR150000.

Change in Operator

An authorization under the general permit is not transferable. If the operator of the regulated project or site changes, the present permittee must submit a Notice of Termination and the new operator must submit a Notice of Intent. The NOT and NOI must be submitted no later than 10 days prior to the change in Operator status.

TCEQ Central Registry Core Data Form

The Core Data Form has been incorporated into this form. Do not send a Core Data Form to TCEQ.

After final acknowledgment of coverage under the general permit, the program will assign a Customer Number and Regulated Entity Number, if one has not already been assigned to this customer or site.

For existing customers and sites, you can find the Customer Number and Regulated Entity Number by entering the following web address into your internet browser: http://www15.tceq.texas.gov/crpub/ or you can contact the TCEQ Stormwater Processing Center at 512-239-3700 for assistance. On the website, you can search by your permit number, the Regulated Entity (RN) number, or the Customer Number (CN). If you do not know these numbers, you can select “Advanced Search” to search by permittee name, site address, etc.

The Customer (Permittee) is responsible for providing consistent information to the TCEQ, and for updating all CN and RN data for all authorizations as changes occur. For this permit, a Notice of Change form must be submitted to the program area.

INSTRUCTIONS FOR FILLING OUT THE NOI FORM

Renewal of General Permit. Dischargers holding active authorizations under the expired General Permit are required to submit a NOI to continue coverage. The existing permit number is required. If the permit number is not provided or has been terminated, expired, or denied, a new permit number will be issued.

Section 1. OPERATOR (APPLICANT)

a) Customer Number (CN)

TCEQ’s Central Registry will assign each customer a number that begins with CN, followed by nine digits. This is not a permit number, registration number, or license number.

If the applicant is an existing TCEQ customer, the Customer Number is available at the following website: http://www15.tceq.texas.gov/crpub/. If the applicant is not an existing TCEQ customer, leave the space for CN blank.

b) Legal Name of Applicant

Provide the current legal name of the applicant. The name must be provided exactly as filed with the Texas Secretary of State (SOS), or on other legal documents forming the entity, as filed in the county. You may contact the SOS at 512-463-5555, for more information related to filing in Texas.

If filed in the county, provide a copy of the legal documents showing the legal name.

c) Contact Information for the Applicant (Responsible Authority)

Provide information for the person signing the application in the Certification section. This person is also referred to as the Responsible Authority.

Provide a complete mailing address for receiving mail from the TCEQ. The mailing address must be recognized by the US Postal Service. You may verify the address on the following website:

https://tools.usps.com/go/ZipLookupAction!input.action.

The phone number should provide contact to the applicant.

The fax number and e-mail address are optional and should correspond to the applicant.

d) Type of Customer (Entity Type)

Check only one box that identifies the type of entity. Use the descriptions below to identify the appropriate entity type. Note that the selected entity type also indicates the name that must be provided as an applicant for an authorization.

Individual

An individual is a customer who has not established a business, but conducts an activity that needs to be regulated by the TCEQ.

Partnership

A customer that is established as a partnership as defined by the Texas Secretary of State Office (TX SOS). If the customer is a ‘General Partnership’ or ‘Joint Venture’ filed in the county (not filed with TX SOS), the legal name of each partner forming the ‘General Partnership’ or ‘Joint Venture’ must be provided. Each ‘legal entity’ must apply as a co-applicant.

Trust or Estate

A trust and an estate are fiduciary relationships governing the trustee/executor with respect to the trust/estate property.

Sole Proprietorship (DBA)

A sole proprietorship is a customer that is owned by only one person and has not been incorporated. This business may:

1. be under the person’s name

2. have its own name (doing business as or DBA)

3. have any number of employees.

If the customer is a Sole Proprietorship or DBA, the ‘legal name’ of the individual business ‘owner’ must be provided. The DBA name is not recognized as the ‘legal name’ of the entity. The DBA name may be used for the site name (regulated entity).

Corporation

A customer that meets all of these conditions:

1. is a legally incorporated entity under the laws of any state or country

2. is recognized as a corporation by the Texas Secretary of State

3. has proper operating authority to operate in Texas

The corporation’s ‘legal name’ as filed with the Texas Secretary of State must be provided as applicant. An ‘assumed’ name of a corporation is not recognized as the ‘legal name’ of the entity.

Government

Federal, state, county, or city government (as appropriate)

The customer is either an agency of one of these levels of government or the governmental body itself. The government agency’s ‘legal name’ must be provided as the applicant. A department name or other description of the organization is not recognized as the ‘legal name’.

Other

This may include a utility district, water district, tribal government, college district, council of governments, or river authority. Provide the specific type of government.

e) Independent Entity

Check No if this customer is a subsidiary, part of a larger company, or is a governmental entity.

Otherwise, check Yes.

f) Number of Employees

Check one box to show the number of employees for this customer’s entire company, at all locations. This is not necessarily the number of employees at the site named in the application.

g) Customer Business Tax and Filing Numbers

These are required for Corporations and Limited Partnerships. These are not required for Individuals, Government, and Sole Proprietors.

State Franchise Tax ID Number

Corporations and limited liability companies that operate in Texas are issued a franchise tax identification number. If this customer is a corporation or limited liability company, enter the Tax ID number.

Federal Tax ID

All businesses, except for some small sole proprietors, individuals, or general partnerships should have a federal taxpayer identification number (TIN). Enter this number here. Use no prefixes, dashes, or hyphens. Sole proprietors, individuals, or general partnerships do not need to provide a federal tax ID.

TX SOS Charter (filing) Number

Corporations and Limited Partnerships required to register with the Texas Secretary of State are issued a charter or filing number. You may obtain further information by calling SOS at 512-463-5555.

DUNS Number

Most businesses have a DUNS (Data Universal Numbering System) number issued by Dun and Bradstreet Corp. If this customer has one, enter it here.

Section 2. APPLICATION CONTACT

Provide the name and contact information for the person that TCEQ can contact for additional information regarding this application.

Section 3. REGULATED ENTITY (RE) INFORMATION ON PROJECT OR SITE

a) Regulated Entity Number (RN)

The RN is issued by TCEQ’s Central Registry to sites where an activity is regulated by TCEQ. This is not a permit number, registration number, or license number. Search TCEQ’s Central Registry to see if the site has an assigned RN at http://www15.tceq.texas.gov/crpub/. If this regulated entity has not been assigned an RN, leave this space blank.

If the site of your business is part of a larger business site, an RN may already be assigned for the larger site. Use the RN assigned for the larger site.

If the site is found, provide the assigned RN and provide the information for the site to be authorized through this application. The site information for this authorization may vary from the larger site information.

An example is a chemical plant where a unit is owned or operated by a separate corporation that is accessible by the same physical address of your unit or facility. Other examples include industrial parks identified by one common address but different corporations have control of defined areas within the site. In both cases, an RN would be assigned for the physical address location and the permitted sites would be identified separately under the same RN.

b) Name of the Project or Site

Provide the name of the site or project as known by the public in the area where the site is located. The name you provide on this application will be used in the TCEQ Central Registry as the Regulated Entity name.

c) Description of Activity Regulated

In your own words, briefly describe the primary business that you are doing that requires this authorization. Do not repeat the SIC Code description.

d) County

Provide the name of the county where the site or project is located. If the site or project is located in more than one county, provide the county names as secondary.

e) Latitude and Longitude

Enter the latitude and longitude of the site in degrees, minutes, and seconds or decimal form. For help obtaining the latitude and longitude, go to:

http://www.tceq.texas.gov/gis/sqmaview.html.

f) Site Address/Location

If a site has an address that includes a street number and street name, enter the complete address for the site in Section A. If the physical address is not recognized as a USPS delivery address, you may need to validate the address with your local police (911 service) or through an online map site used to locate a site. Please confirm this to be a complete and valid address. Do not use a rural route or post office box for a site location.

If a site does not have an address that includes a street number and street name, provide a complete written location description in Section B. For example: “The site is located on the north side of FM 123, 2 miles west of the intersection of FM 123 and Highway 1.”

Provide the city (or nearest city) and zip code of the site location.

Section 4. GENERAL CHARACTERISTICS

a) Indian Country Lands

If your site is located on Indian Country Lands, the TCEQ does not have authority to process your application. You must obtain authorization through EPA Region 6, Dallas.

Do not submit this form to TCEQ.

b) Construction activity associated with facility associated with exploration, development, or production of oil, gas, or geothermal resources

If your activity is associated with oil and gas exploration, development, or production, you may be under jurisdiction of the Railroad Commission of Texas (RRC) and may need to obtain authorization from EPA Region 6.

Construction activities associated with a facility related to oil, gas or geothermal resources may include the construction of a well site; treatment or storage facility; underground hydrocarbon or natural gas storage facility; reclamation plant; gas processing facility;

compressor station; terminal facility where crude oil is stored prior to refining and at which refined products are stored solely for use at the facility; a carbon dioxide geologic storage facility; and a gathering, transmission, or distribution pipeline that will transport crude oil or natural gas, including natural gas liquids, prior to refining of such oil or the use of the natural gas in any manufacturing process or as a residential or industrial fuel.

Where required by federal law, discharges of stormwater associated with construction activities under the RRC’s jurisdiction must be authorized by the EPA and the RRC, as applicable. Activities under RRC jurisdiction include construction of a facility that, when completed, would be associated with the exploration, development, or production of oil or gas or geothermal resources, such as a well site; treatment or storage facility; underground hydrocarbon or natural gas storage facility; reclamation plant; gas processing facility;

compressor station; terminal facility where crude oil is stored prior to refining and at which refined products are stored solely for use at the facility; a carbon dioxide geologic storage facility under the jurisdiction of the RRC; and a gathering, transmission, or distribution pipeline that will transport crude oil or natural gas, including natural gas liquids, prior to refining of such oil or the use of the natural gas in any manufacturing process or as a residential or industrial fuel. The RRC also has jurisdiction over stormwater from land disturbance associated with a site survey that is conducted prior to construction of a facility that would be regulated by the RRC. Under 33 U.S.C.

§1342(l)(2) and §1362(24), EPA cannot require a permit for discharges of stormwater from field activities or operations associated with {oil and gas} exploration, production, processing, or treatment operations, or transmission facilities, including activities necessary to prepare a site for drilling and for the movement and placement of drilling equipment, whether or not such field activities or operations may be considered to be construction activities unless the discharge is contaminated by contact with any overburden, raw material, intermediate product, finished product, byproduct, or waste product located on the site of the facility. Under §3.8 of this title (relating to Water Protection), the RRC prohibits operators from causing or allowing pollution of surface or subsurface water. Operators are encouraged to implement and maintain best management practices (BMPs) to minimize discharges of pollutants, including sediment, in stormwater during construction activities to help ensure protection of surface water quality during storm events.

For more information about the jurisdictions of the RRC and the TCEQ, read the Memorandum of Understanding (MOU) between the RRC and TCEQ at 16 Texas Administrative Code, Part 1, Chapter 3, Rule 3.30, by entering the following link into an internet browser:

http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc= &p_tloc=&p_ploc=&pg=1&p_tac=&ti=16&pt=1&ch=3&rl=30 or contact the TCEQ Stormwater Team at 512-239-4671 for additional information.

c) Primary Standard Industrial Classification (SIC) Code

Provide the SIC Code that best describes the construction activity being conducted at this site.

Common SIC Codes related to construction activities include:

1521 - Construction of Single Family Homes

1522 - Construction of Residential Buildings Other than Single Family Homes

1541 - Construction of Industrial Buildings and Warehouses

1542 - Construction of Non-residential Buildings, other than Industrial Buildings and Warehouses

1611 - Highway and Street Construction, except Highway Construction

1622 - Bridge, Tunnel, and Elevated Highway Construction

1623 - Water, Sewer, Pipeline and Communications, and Power Line Construction

For help with SIC Codes, enter the following link into your internet browser:

http://www.osha.gov/pls/imis/sicsearch.html or you can contact the TCEQ Small Business and Local Government Assistance Section at 800-447-2827 for assistance.

d) Secondary SIC Code

Secondary SIC Code(s) may be provided. Leave this blank if not applicable. For help with SIC Codes, enter the following link into your internet browser:

http://www.osha.gov/pls/imis/sicsearch.html or you can contact the TCEQ Small Business and Environmental Assistance Section at 800-447-2827 for assistance.

e) Total Number of Acres Disturbed

Provide the approximate number of acres that the construction site will disturb.

Construction activities that disturb less than one acre, unless they are part of a larger common plan that disturbs more than one acre, do not require permit coverage.

Construction activities that disturb between one and five acres, unless they are part of a common plan that disturbs more than five acres, do not require submission of an NOI.

Therefore, the estimated area of land disturbed should not be less than five, unless the project is part of a larger common plan that disturbs five or more acres. Disturbed means any clearing, grading, excavating, or other similar activities.

If you have any questions about this item, please contact the stormwater technical staff by phone at 512-239-4671 or by email at swgp@tceq.texas.gov.

f) Common Plan of Development

Construction activities that disturb less than five acres do not require submission of an NOI unless they are part of a common plan of development or for sale where the area disturbed is five or more acres. Therefore, the estimated area of land disturbed should not be less than five, unless the project is part of a larger common plan that disturbs five or more acres. Disturbed means any clearing, grading, excavating, or other similar activities.

For more information on what a common plan of development is, refer to the definition of “Common Plan of Development” in the Definitions section of the general permit or enter the following link into your internet browser:

www.tceq.texas.gov/permitting/stormwater/common_plan_of_development_steps.html

For further information, go to the TCEQ stormwater construction webpage enter the following link into your internet browser: www.tceq.texas.gov/goto/construction and search for “Additional Guidance and Quick Links”. If you have any further questions about the Common Plan of Development you can contact the TCEQ Stormwater Team at

512-239-4671 or the TCEQ Small Business and Environmental Assistance at 800-447- 2827.

g) Estimated Start Date of the Project

This is the date that any construction activity or construction support activity is initiated at the site. If renewing the permit provide the original start date of when construction activity for this project began.

h) Estimated End Date of the Project

This is the date that any construction activity or construction support activity will end and final stabilization will be achieved at the site.

i) Will concrete truck washout be performed at the site?

Indicate if you expect that operators of concrete trucks will washout concrete trucks at the construction site.

j) Identify the water body(s) receiving stormwater runoff

The stormwater may be discharged directly to a receiving stream or through a MS4 from your site. It eventually reaches a receiving water body such as a local stream or lake, possibly via a drainage ditch. You must provide the name of the water body that receives the discharge from the site (a local stream or lake).

If your site has more than one outfall you need to include the name of the first water body for each outfall, if they are different.

k) Identify the segment number(s) of the classified water body(s)

Identify the classified segment number(s) receiving a discharge directly or indirectly.

Enter the following link into your internet browser to find the segment number of the classified water body where stormwater will flow from the site:

www.tceq.texas.gov/waterquality/monitoring/viewer.html or by contacting the TCEQ Water Quality Division at (512) 239-4671 for assistance.

You may also find the segment number in TCEQ publication GI-316 by entering the following link into your internet browser: www.tceq.texas.gov/publications/gi/gi-316 or by contacting the TCEQ Water Quality Division at (512) 239-4671 for assistance.

If the discharge is into an unclassified receiving water and then crosses state lines prior to entering a classified segment, select the appropriate watershed:

0100 (Canadian River Basin)

0200 (Red River Basin)

0300 (Sulfur River Basin)

0400 (Cypress Creek Basin)

0500 (Sabine River Basin)

Call the Water Quality Assessments section at 512-239-4671 for further assistance.

l) Discharge into MS4 – Identify the MS4 Operator

The discharge may initially be into a municipal separate storm sewer system (MS4). If the stormwater discharge is into an MS4, provide the name of the entity that operates the MS4 where the stormwater discharges. An MS4 operator is often a city, town, county, or utility district, but possibly can be another form of government. Please note that the Construction General Permit requires the Operator to supply the MS4 with a copy of the NOI submitted to TCEQ. For assistance, you may call the technical staff at 512-239-4671.

m) Discharges to the Edwards Aquifer Recharge Zone and Certification

The general permit requires the approved Contributing Zone Plan or Water Pollution Abatement Plan to be included or referenced as a part of the Stormwater Pollution Prevention Plan.

See maps on the TCEQ website to determine if the site is located within the Recharge Zone, Contributing Zone, or Contributing Zone within the Transition Zone of the Edwards Aquifer by entering the following link into an internet browser:

www.tceq.texas.gov/field/eapp/viewer.html or by contacting the TCEQ Water Quality Division at 512-239-4671 for assistance.

If the discharge or potential discharge is within the Recharge Zone, Contributing Zone, or Contributing Zone within the Transition Zone of the Edwards Aquifer, a site-specific authorization approved by the Executive Director under the Edwards Aquifer Protection Program (30 TAC Chapter 213) is required before construction can begin.

For questions regarding the Edwards Aquifer Protection Program, contact the appropriate TCEQ Regional Office. For projects in Hays, Travis and Williamson Counties: Austin Regional Office, 12100 Park 35 Circle, Austin, TX 78753, 512-339- 2929. For Projects in Bexar, Comal, Kinney, Medina and Uvalde Counties: TCEQ San Antonio Regional Office, 14250 Judson Rd., San Antonio, TX 78233-4480, 210-490- 3096.

Section 5. NOI CERTIFICATION

Note: Failure to indicate Yes to all of the certification items may result in denial of coverage under the general permit.

a) Certification of Understanding the Terms and Conditions of Construction General Permit (TXR150000)

Provisional coverage under the Construction General Permit (TXR150000) begins 7 days after the completed paper NOI is postmarked for delivery to the TCEQ. Electronic applications submitted through ePermits have immediate provisional coverage. You must obtain a copy and read the Construction General Permit before submitting your application. You may view and print the Construction General Permit for which you are seeking coverage at the TCEQ web site by entering the following link into an internet browser: www.tceq.texas.gov/goto/construction or you may contact the TCEQ Stormwater processing Center at 512-239-3700 for assistance.

b) Certification of Legal Name

The full legal name of the applicant as authorized to do business in Texas is required. The name must be provided exactly as filed with the Texas Secretary of State (SOS), or on other legal documents forming the entity, that is filed in the county where doing business.

You may contact the SOS at 512-463 5555, for more information related to filing in Texas.

c) Understanding of Notice of Termination

A permittee shall terminate coverage under the Construction General Permit through the submittal of a NOT when the operator of the facility changes, final stabilization has been reached, the discharge becomes authorized under an individual permit, or the construction activity never began at this site.

d) Certification of Stormwater Pollution Prevention Plan

The SWP3 identifies the areas and activities that could produce contaminated runoff at your site and then tells how you will ensure that this contamination is mitigated. For example, in describing your mitigation measures, your site's plan might identify the devices that collect and filter stormwater, tell how those devices are to be maintained, and tell how frequently that maintenance is to be carried out. You must develop this plan in accordance with the TCEQ general permit requirements. This plan must be developed and implemented before you complete this NOI. The SWP3 must be available for a TCEQ investigator to review on request.

Section 6. APPLICANT CERTIFICATION SIGNATURE

The certification must bear an original signature of a person meeting the signatory requirements specified under 30 Texas Administrative Code (TAC) §305.44.

If you are a corporation:

The regulation that controls who may sign an NOI or similar form is 30 Texas Administrative Code §305.44(a)(1) (see below). According to this code provision, any corporate representative may sign an NOI or similar form so long as the authority to sign such a document has been delegated to that person in accordance with corporate procedures. By signing the NOI or similar form, you are certifying that such authority has been delegated to you. The TCEQ may request documentation evidencing such authority.

If you are a municipality or other government entity:

The regulation that controls who may sign an NOI or similar form is 30 Texas Administrative Code §305.44(a)(3) (see below). According to this code provision, only a ranking elected official or principal executive officer may sign an NOI or similar form.

Persons such as the City Mayor or County Commissioner will be considered ranking elected officials. In order to identify the principal executive officer of your government entity, it may be beneficial to consult your city charter, county or city ordinances, or the Texas statute(s) under which your government entity was formed. An NOI or similar document that is signed by a government official who is not a ranking elected official or principal executive officer does not conform to §305.44(a)(3). The signatory requirement may not be delegated to a government representative other than those identified in the regulation. By signing the NOI or similar form, you are certifying that you are either a ranking elected official or principal executive officer as required by the administrative code. Documentation demonstrating your position as a ranking elected official or principal executive officer may be requested by the TCEQ.

If you have any questions or need additional information concerning the signatory requirements discussed above, please contact the TCEQ’s Environmental Law Division at 512-239-0600.

30 Texas Administrative Code

§305.44. Signatories to Applications

(a) All applications shall be signed as follows.

(1) For a corporation, the application shall be signed by a responsible corporate officer. For purposes of this paragraph, a responsible corporate officer means a president, secretary, treasurer, or vice-president of the corporation in charge of a principal business function, or any other person who performs similar policy or decision- making functions for the corporation; or the manager of one or more manufacturing, production, or operating facilities employing more than 250 persons or having gross annual sales or expenditures exceeding $25 million (in second-quarter 1980 dollars), if authority to sign documents has been assigned or delegated to the manager in accordance with corporate procedures. Corporate procedures governing authority to sign permit or post-closure order applications may provide for assignment or delegation to applicable corporate positions rather than to specific individuals.

(2) For a partnership or sole proprietorship, the application shall be signed by a general partner or the proprietor, respectively.

(3) For a municipality, state, federal, or other public agency, the application shall be signed by either a principal executive officer or a ranking elected official. For purposes of this paragraph, a principal executive officer of a federal agency includes the chief executive officer of the agency, or a senior executive officer having responsibility for the overall operations of a principal geographic unit of the agency (e.g., regional administrator of the EPA).

Instructions:

Use this form to submit your Application Fee only if you are mailing your payment.

Texas Commission on Environmental Quality General Permit Payment Submittal Form

Complete items 1 through 5 below:

Staple your check in the space provided at the bottom of this document.

Do not mail this form with your NOI form.

Do not mail this form to the same address as your NOI.

Mail this form and your check to either of the following:

By Regular U.S. Mail Texas Commission on Environmental Quality Financial Administration Division Cashier’s Office, MC-214 P.O. Box 13088 Austin, TX 78711-3088

By Overnight or Express Mail Texas Commission on Environmental Quality Financial Administration Division Cashier’s Office, MC-214 12100

Park 35 Circle Austin, TX 78753

Fee Code: GPA General Permit: TXR150000

1. Check or Money Order No: Click here to enter text.

2. Amount of Check/Money Order: Click here to enter text.

3. Date of Check or Money Order: Click here to enter text.

4. Name on Check or Money Order: Click here to enter text.

5. NOI Information:

If the check is for more than one NOI, list each Project or Site (RE) Name and Physical Address exactly as provided on the NOI. Do not submit a copy of the NOI with this form, as it could cause duplicate permit application entries!

If there is not enough space on the form to list all of the projects or sites the authorization will cover, then attach a list of the additional sites.

Project/Site (RE) Name: Click here to enter text. Project/Site (RE) Physical Address:

Click here to enter text.

Staple the check or money order to this form in this space.

TCEQ-20134 (03/06/2018) Page 1

ATTACHMENT 2

SMALL CONSTRUCTION SITE NOTICE

FOR THE

Texas Commission on Environmental Quality (TCEQ) Stormwater Program

TPDES GENERAL PERMIT TXR150000

The following information is posted in compliance with Part II.E.2. of the TCEQ General Permit Number TXR150000 for discharges of stormwater runoff from small construction sites. Additional information regarding the TCEQ stormwater permit program may be found on the internet at:

http://www.tceq.state.tx.us/nav/permits/wq_construction.html

Operator Name:

Contact Name and Phone Number:

Project Description: Physical address or description of the site’s location, estimated start date and projected end date, or date that disturbed soils will be stabilized

Location of Stormwater Pollution Prevention Plan:

For Small Construction Activities Authorized Under Part II.E.2. (Obtaining Authorization to Discharge) the following certification must be completed:

I (Typed or Printed Name Person Completing This Certification) certify under penalty of law that I have read and understand the eligibility requirements for claiming an authorization under Part II.E.2. of TPDES General Permit TXR150000 and agree to comply with the terms of this permit. A stormwater pollution prevention plan has been developed and will be implemented prior to construction, according to permit requirements. A copy of this signed notice is supplied to the operator of the MS4 if discharges enter an MS4. I am aware there are significant penalties for providing false information or for conducting unauthorized discharges, including the possibility of fine and imprisonment for knowing violations.

Signature and Title Date

Date Notice Removed

MS4 operator notified per Part II.F.3.

http://www.tceq.state.tx.us/nav/permits/wq_construction.html

ATTACHMENT 3

TPDES OPERATOR'S INFORMATION

Owner's Name and Address: City of Houston

Mr.

(City Official)

(Department)

1002 Washington Ave, 2nd FL Houston, TX 77002

(832) 394-9108

Contractors' Names and Addresses:

General Contractor:

Telephone:

Site Superintendent:

Telephone:

Erosion Control and Maintenance Inspection:

Telephone:

Subcontractors' Names and Addresses:

Phone: Phone:

Note: Insert name, address, and telephone number of person or firms

ATTACHMENT 4

CONTRACTOR'S / SUBCONTRACTOR'S

CERTIFICATION FOR TPDES PERMITTING

I certify under penalty of law that I understand the terms and conditions of TPDES General Permit No. TXR150000 and the Storm Water Pollution Prevention Plan for the construction site identified as part of this certification.

Signature:

Name: (printed or typed)

Title:

Company:

Address:

Date:

Signature:

Name: (printed or typed)

Title:

Company:

Address:

Date:

Signature:

Name: (printed or typed)

Title:

Company:

Address:

Date:

ATTACHMENT 5

~~ City of Houston $ ~ Storm Water Quality

~-~ Construction Site Activities Inspection Report

TCEQ Stormwater Discharge Permit Number _______ _

COH Storm Water Quality Permit Number _______ _

COH Building Permit Login Number _______ _

NAME ____________ DATE ______ _

ADDRESS __________________ _

□ No exceptions noted.

The following deficiencies have been noted:

D NOi / Construction Site Notice Improperly Posted

D Stormwater Pollution Prevention Plan Incomplete or requires updating

D Copy of NOi / CSN not on site

D Storm Water Pollution Prevention Plan not on site

D Erosion and sediment controls improperly installed

D Erosion and sediment control devices improperly maintained

D Fueling/washout/chemical storage areas not properly protected

D Portocan or other sanitary facilities not property protected or leaking

D Self-inspection and maintenance records incomplete

D Sediment from site outside area of construction

D Other (see description below)

The deficiencies must be corrected:

□ immediately; □ within 48 hours;

□ prior to re-inspection

Should the noted deficiencies not be corrected in the time frame indicated, further enforcement remedies will be sought.

For questions concerning the above:

Please contact the Storm Water Quality Group at

1002 Washington Avenue, 2nd Floor, Houston TX 77002 832-394-9108

Inspector's Name

Inspector's Cell Phone

Operator's Signature

Operator's Name

□ not present

Distribution: white - Stormwater Quality Engineer gold - operator

PW&E 554

ATTACHMENT 6

TCEQ Office Use Only Permit No:

CN:

RN:

Region:

Notice of Termination (NOT) for Authorizations under TPDES General Permit TXR150000

IMPORTANT INFORMATION:

Please read and use the General Information and Instructions prior to filling out each question in the form.

Effective September 1, 2018, this paper form must be submitted to TCEQ with a completed electronic reporting waiver form (TCEQ-20754).

ePermits: This form is available on our online permitting system.

Sign up for online permitting at: https://www3.tceq.texas.gov/steers/

What is the permit number to be terminated?

TXR15 enter permit number here TXRCW enter permit number here

Section 1. OPERATOR (Permittee)

a) What is the Customer Number (CN) issued to this entity?

CN enter customer number here

b) What is the Legal Name of the current permittee?

Enter legal name of current permittee here

c) Provide the contact information for the Operator (Responsible Authority).

Prefix (Mr. Ms. or Miss): enter prefix here

First and Last Name: enter first and last name here Suffix: enter suffix here

Title: enter title here Credentials: enter credentials

Phone Number: enter phone number here Fax Number: enter fax number here

Email: enter email address here

Mailing Address: enter mailing street number and name here

City, State, and Zip Code: enter city, state, and zip code here

Country Mailing Information, if outside USA: enter country mailing info here

Section 2. APPLICATION CONTACT

This is the person TCEQ will contact if additional information is needed regarding this application.

Is the application contact the same as the permittee identified above?

Yes, go to Section 3.

TCEQ-20023 (03/09/2018) Page 1 Notice of Termination for TXR150000

• -!!l ~

• iiii§I -TCEQ

No, complete section below

Prefix (Mr. Ms. or Miss): enter prefix here

First and Last Name: enter first and last name here Suffix: enter suffix here

Title: enter title here Credentials: enter credentials here

Phone Number: enter phone number here Fax Number: enter fax number here

Email: enter email address here

Mailing Address: enter mailing street number and name here

City, State, and Zip Code: enter city, state, and zip code here

Country Mailing Information, if outside USA: enter country mailing info here

Section 3. REGULATED ENTITY (RE) INFORMATION ON PROJECT OR SITE

a) TCEQ issued RE Reference Number (RN): RN enter regulated entity number here

b) Name of project or site as known by the local community: enter site name here

c) County, or counties if more than 1: enter counties where site is located here

d) Latitude: enter latitude here Longitude: enter longitude here

e) Site Address/Location:

If the site has a physical address such as 12100 Park 35 Circle, Austin, TX 78753, complete Section 3A.

If the site does not have a physical address, provide a location description in Section 3B.

Example: located on the north side of FM 123, 2 miles west of the intersection of FM 123 and Highway 1.

Section 3A: Physical Address of Project or Site:

Street Number and Name: enter street number and name here

City, State, and Zip Code: enter city, state, and zip code here

Section 3B: Site Location Description:

Location description: enter location description here. Example: located on the north side of FM 123, 2 miles west of the intersection of FM 123 and Highway 1

City where the site is located or, if not in a city, what is the nearest city: enter city here

Zip Code where the site is located: enter zip code here

Section 4. REASON FOR TERMINATION

Check the reason for termination:

Final stabilization has been achieved on all portions of the site that are the responsibility of the Operator and all silt fences and other temporary erosion controls have been removed, or scheduled for removal as defined in the SWP3.

TCEQ-20023 (03/09/2018) Page 2 Notice of Termination for TXR150000

I

Another permitted Operator has assumed control over all areas of the site that have not been finally stabilized, and temporary erosion controls that have been identified in the

SWP3 have been transferred to the new Operator.

The discharge is now authorized under an alternate TPDES permit.

The activity never began at this site that is regulated under the general permit.

Section 5. CERTIFICATION

Signatory Name: enter signatory name here

Signatory Title: enter signatory title here

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 gather and evaluate 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 there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.

I further certify that I am authorized under 30 Texas Administrative Code §305.44 to sign and submit this document, and can provide documentation in proof of such authorization upon request.

Signature (use blue ink): Date:

TCEQ-20023 (03/09/2018) Page 3 Notice of Termination for TXR150000

I

TCEQ-20023 (03/09/2018)

Instructions for Notice of Termination for TXR150000

GENERAL INFORMATION

Where to Send the Notice of Termination (NOT):

Instructions for Notice of Termination (NOT) for Authorizations under TPDES General Permit TXR150000

BY REGULAR U.S. MAIL:

Texas Commission on Environmental Quality

Stormwater Processing Center (MC-228)

P.O. Box 13087

Austin, Texas 78711-3087

BY OVERNIGHT/EXPRESS MAIL:

Texas Commission on Environmental Quality

Stormwater Processing Center (MC-228)

12100 Park 35 Circle

Austin, TX 78753

TCEQ Contact List:

Application status and form questions: 512-239-3700, swpermit@tceq.texas.gov Technical questions: 512-239-4671, swgp@tceq.texas.gov Environmental Law Division: 512-239-0600

Records Management - obtain copies of forms: 512-239-0900

Reports from databases (as available): 512-239-DATA (3282) Cashier’s office: 512 239-0357 or 512-239-0187

Notice of Termination Process:

A Notice of Termination is effective on the date postmarked for delivery to TCEQ.

When your NOT is received by the program, the form will be processed as follows:

1) Administrative Review: The form will be reviewed to confirm the following:

• the permit number is provided;

• the permit is active and has been approved;

• the entity terminating the permit is the current permittee;

• the site information matches the original permit record; and

• the form has the required original signature with title and date.

2) Notice of Deficiency: If an item is incomplete or not verifiable as indicated above, a phone call will be made to the applicant to clear the deficiency. A letter will not be sent to the permittee if unable to process the form.

3) Confirmation of Termination: A Notice of Termination Confirmation letter will be mailed to the operator.

Change in Operator:

An authorization under the general permit is not transferable. If the operator of the regulated entity changes, the present permittee must submit a Notice of Termination and the new operator must submit a Notice of Intent. The NOT and NOI must be submitted not later than 10 days prior to the change in Operator status.

INSTRUCTIONS FOR FILLING OUT THE FORM

The majority of permit information related to the current operator and regulated entity are available at the following website: http://www2.tceq.texas.gov/wq_dpa/index.cfm.

mailto:swpermit@tceq.texas.gov mailto:swgp@tceq.texas.gov http://www2.tceq.texas.gov/wq_dpa/index.cfm

Section 1. Operator (Current Permittee):

a) Customer Number (CN)

TCEQ’s Central Registry assigns each customer a number that begins with CN, followed by nine digits. This is not a permit number, registration number, or license number. The

Customer Number, for the current permittee, is available at the following website:

http://www2.tceq.texas.gov/wq_dpa/index.cfm.

b) Legal Name of Operator The operator must be the same entity as previously submitted on the original Notice of

Intent for the permit number provided. The current operator name, as provided on the current authorization, is available at the following website:

http://www2.tceq.texas.gov/wq_dpa/index.cfm.

c) Contact Information for the Operator (Responsible Authority) Provide information for person signing the NOT application in the Certification section.

This person is also referred to as the Responsible Authority.

Provide a complete mailing address for receiving mail from the TCEQ. Update the address if different than previously submitted for the Notice of Intent or Notice of Change. The mailing address must be recognized by the US Postal Service. You may verify the address on the following website: https://tools.usps.com/go/ZipLookupAction!input.action.

The phone number should provide contact to the operator.

The fax number and e-mail address are optional and should correspond to the operator.

Section 2. Application Contact:

Provide the name, title and contact information of the person that TCEQ can contact for additional information regarding this application.

Section 3. Regulated Entity (RE) Information on Project or Site:

a) Regulated Entity Reference Number (RN) A number issued by TCEQ’s Central Registry to sites where an activity regulated by TCEQ.

This is not a permit number, registration number, or license number. The Regulated Entity

Reference Number is available at the following website:

http://www2.tceq.texas.gov/wq_dpa/index.cfm.

b) Name of the Project or Site Provide the name of the site as known by the public in the area where the site is located.

c) County Identify the county or counties in which the regulated entity is located.

d) Latitude and Longitude Enter the latitude and longitude of the site in degrees, minutes, and seconds or decimal form. The latitude and longitude as provided on the current authorization is available at the following website: http://www2.tceq.texas.gov/wq_dpa/index.cfm.

e) Site/Project (RE) Physical Address/Location Information The physical address/location information, as provided on the current authorization, is available at the following website: http://www2.tceq.texas.gov/wq_dpa/index.cfm.

http://www2.tceq.texas.gov/wq_dpa/index.cfm http://www2.tceq.texas.gov/wq_dpa/index.cfm http://www2.tceq.texas.gov/wq_dpa/index.cfm

Section 3A. If a site has an address that includes a street number and street name, enter the complete address for the site. If the physical address is not recognized as a USPS delivery address, you may need to validate the address with your local police (911 service) or through an online map site used to locate the site. Please confirm this to be a complete and valid address. Do not use a rural route or post office box for a site location.

Section 3B. If a site does not have an address that includes a street number and street name, provide a complete written location description. For example: "The site is located on the north side of FM 123, 2 miles west of the intersection of FM 123 and Highway 1."

Provide the city (or nearest city) and Zip Code of the facility location.

Section 4. Reason for Termination:

The Notice of Termination form is only for use to terminate the authorization (permit). The

Permittee must indicate the specific reason for terminating by checking one of the options. If the reason is not listed then provide an attachment that explains the reason for termination.

Please read your general permit carefully to determine when to terminate your permit. Permits will not be reactivated after submitting a termination form. The termination is effective on the date postmarked for delivery to TCEQ.

Section 5. Certification:

The certification must bear an original signature of a person meeting the signatory requirements specified under 30 Texas Administrative Code §305.44.

IF YOU ARE A CORPORATION:

The regulation that controls who may sign an application form is 30 Texas Administrative Code §305.44(a), which is provided below. According to this code provision, any corporate representative may sign an NOI or similar form so long as the authority to sign such a document has been delegated to that person in accordance with corporate procedures.