CM-2022-199 - 8/26/2022Agent Authorization Form
For Required Signature
Edwards Aquifer Protection Program
Relating to 30 TAC Chapter 213
Effective June 1, 1999
er
of the City of Round Rock ,
Corporation/Partnership/Entity Name
have authorized Katie Baker. PLA _
Print Name of Agent/Engineer
of City of Round Rock, PARD
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:
Applic nt's Signature
THE STATE OF 6 §
Countyof L-111towLYON
g- .2
l
Date
BEFORE ME, the undersigned authority, on this day personally appeared I - 6 D&Qnown
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 2(?aay of v�ZZ
ARY PU C
t�IONIQUE/�DAMS �-
.a My Notary lD # IMS7913 O N
Expka March 22.2026 Typed or Printed Name of Notary
MY COMMISSION EXPIRES:
/ z-z�
TCEQ-0599 (Rev.0410112010) Page 2 of 2
ROUND ROCK
TEXAS
City of Round Rock
Agenda Item Summary
Agenda Number:
Title: Consider executing "Agent Authorization Form For Required Signature Edwards
Aquifer Protection Program Relating to 30 TAC Chapter 213" authorizing Katie
Baker of the City of Round Rock to represent and act on behalf of the City for the
Mayfield Park Archery Project.
Type: City Manager Item
Governing Body: City Manager Approval
Agenda Date: 8/26/2022
Dept Director: Rick Atkins, Parks and Recreation Department Director
Cost: $0.00
Indexes:
Attachments: LAF - Agent Authorization Form TCEQ - (Katie Baker) -Mayfield Park Archery,
TCEQ Agent Authorization Form 0599
Department: Parks & Recreation
Text of Legislative File CM-2022-199
This item authorizes Katie Baker to act on behalf of the city for the Mayfield Park Archery Project 2022.
Texas Commission on Environmental Quality (TCEQ) application. Mayfield Park is located over the Edwards
Aquifer Recharge & Contributing zones therefore approval from TCEQ is required prior to bidding and
construction.
Mayfield Park Archery Project includes:
1) Gravel Driveway
2) ADA accessible concrete pads
This item is funded through Parks Improvement & Acquisition Fund
NOTE: This signed authorization must be attached to submittal paperwork by department to TCEQ. Please
return original signed authorization to the department, attention Katie Baker.
City of Round Rock Page 1 of 1