CM-2017-1500 - 10/11/2017 Agent Authorization Form
For Required Signature
Edwards Aquifer Protection Program
Relating to 30 TAC Chapter 213
Effective June 1, 1999
I Laurie Hadley ,
Print Name
City Manager ,
Title - Owner/President/Other
of City of Round Rock ,
Corporation/Partnership/Entity Name
have authorized Karla Brawner, P.E.
Print Name of Agent/Engineer
of Halff Associates Inc.
Print Name of Firm
to represent and act on the behalf of the above named Corporation, Partnership, or Entity for
the purpose of preparing and submitting this plan application to the Texas Commission on
Environmental Quality (TCEQ) for the review and approval consideration of regulated
activities.
I also understand that:
1. The applicant is responsible for compliance with 30 Texas Administrative Code
Chapter 213 and any condition of the TCEQ's approval letter. The TCEQ is authorized
to assess administrative penalties of up to $10,000 per day per violation.
2. For those submitting an application who are not the property owner, but who have the
right to control and possess the property, additional authorization is required from the
owner.
3. Application fees are due and payable at the time the application is submitted. The
application fee must be sent to the TCEQ cashier or to the appropriate regional office.
The application will not be considered until the correct fee is received by the
commission.
4. A notarized copy of the Agent Authorization Form must be provided for the person
preparing the application, and this form must accompany the completed application.
5. No person shall commence any regulated activity on the Edwards Aquifer Recharge
Zone, Contributing Zone or Transition Zone until the appropriate application for the
activity has been filed with and approved by the Executive Director.
TCEQ-0599(Rev.04/01/2010) Page 1 of 2
SIGNATURE PAGE:
26 a�� / 2i�
App ` ant's Signature Date
THE STATE OF §
County of \Njj, A §
BEFORE ME, the undersigned authority, on this day personally appearedM
IW'M�AAWI# known
to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged to
me that (s)he executed same for the purpose and consideration therein expressed.
GIVEN under my hand and seal of office on this day of
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\`�►NN►�►iii�y��� NOTARY PUBLIC
93
P(/e��c• •'�•�� Typed or Printed Name of Notary
d I ��TO
MY COMMISSION EXPIRES: (
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TCEQ-0599(Rev.04/01/2010) Page 2 of 2
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