CM-2017-1553 - 11/17/2017of
Agent Authorization Form
For Required Signature
Edwards Aquifer Protection Program
Relating to 30 TAC Chapter 213
Effective June 1, 1999
ame
Tithe - wner/ rest en Ot er
rporatibn/Partnership/Entity Name
have authorized Don Pool
Print Name of Agent/Engineer
of
Peal and 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 fled with and approved by the Executive Director.
f -S J4 C1
1
TCEO-0599 (Rev 0410112010)
Get-Zor 7- 11553
Page i of 2
SIGNATURE PAGE:
THE STATE OF §
County of Whamidin §
-7--/
Date
BEFORE ME, the undersigned authority, on this day personally appearedLa vre �1t known
to me to be the person whose name is subscribed to the foregoing instrument, and acknow dged to
me that (s)he executed same for the purpose and consideration therein expressed.
GIVEN under my hand and seal of office on this ji day of ,2d 1.
�4`1BLANCA GR115 NO Y PUBLI
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W4FsNotary public, State of Texas
Comm, Expires 03-15-2020 f�
;�rNotary ID 130582387
Typed or PrintecTName of Notary
MY COMMISSION EXPIRES:.? —1 S -2fjw
TCEO-0599 (Rev.04101l2010) Page 2 of 2
City of Round Rock
ROUND ROCK
s
TEXAS Agenda Item Summary
Agenda Number:
Title: Consider authorizing an TCEQ Agent Authorization Form for use at Fire
Station No. 9 naming Don Pool and the authorized agent on behalf of the City
of Round Rock in relation to this project.
Type: City Manager Item
Governing Body: City Manager Approval
Agenda Date: 11/17/2017
Dept Director: Chad McDowell, General Services Director
Cost:
Indexes:
Attachments: Fire Station No. 9, LAF Fire Station No. 9
Department: General Services Department
Text of Legislative File CM -2017-1553
Consider authorizing an TCEQ Agent Authorization Form for use at Fire Station No. 9
naming Don Pool and the authorized agent on behalf of the City of Round Rock in relation
to this project.
The form attached will be used for Fire Station No. 9, Phase 2 project
CJtyalRoundRock Page 1 Printed an 14/17/2017