CM-2022-210 - 9/9/2022Agent 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 Henry_ Parker, RLA
Print Name of Agent/Engineer
of Parkhill. 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:
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 04l01l2010) Page 1 of 2
SIGNATURE PAGE:
Applicant's Signature
THE STATE OF Texas §
County of Williamson §
14-2022-
Date
BEFORE ME, the undersigned authority, on this day personally appeared C� nown
to me to be the person whose name is subscribed to the foregoing instrument, and acknowl dged to
me that (s)he executed same for the purpose and consideration erein expressed.
GIVEN under my hand and seal of office on this�day of , NOTARY PUBLIC)
MONIQUEAD"
*= MYNolarylD 126257 3 Typed or Printed Name of Notary
March 22, 2025
MY COMMISSION EXPIRES: ZZ�2oz-�
TCEQ-0599 (Rev.0410112010) Page 2 of 2
TCEQ Use Only
W TCEQ Core Data Form
For detailed instructions regarding completion of this form, please read the Core Data Form Instructions or call 512-239-5175.
SECTION I: General Information
1. Reason for Submission (if other is checked please describe in space provided.)
® New Permit, Registration or Authorization (Core Data Form should be submitted with the program application.)
❑ Renewal (Core Data Form should be submitted with the renewal form) ❑ Other
2. Customer Reference Number if issued Follow this link to search 3. Regulated Entity Reference Number if issued
for CN or RN numbers in
CN Central Registry" RN
SECTION II: Customer Information
4. General Customer information
5. Effective Date for Customer Information Updates (mmlddfyyyy)
® New Customer ❑ Update to Customer Information ❑ Change in Regulated Entity Ownership
❑Change in Legal game (Verifiable with the Texas Secretary of State or Texas Comptroller of Public Accounts)
The Customer Name submitted here may be updated automatically based on what is current and active with the
Texas Secretary of State (SOS) or Texas Comptroller of Public Accounts (CPA).
6. Customer Legal Name (if an individual, print last name first eg: Doe, John) !f new Customer._ enter previous Customer below:
City of Round Rock
7. TX SOSICPA Filing Number
8. TX State Tax ID tit digttsl
9. Federal Tax ID is digest
10. DUNS Number (uspoicawi
11. Type of Customer:
Corporation
Individual
Partnership: ❑General ❑ Limited
Government: ® City ❑ County ❑ Federal ❑ State ❑ other
❑ Sole Proprietorship
❑ Other:
12. Number of Employees
❑ 0-20 ❑ 21-100 ❑ 101-250 ❑ 251-500 ❑ 501 and higher
13. Independently Owned and Operated?
❑ Yes ® No
14. Customer Role (Proposed or Actual) — as it relates to the Regulated Entity listed on this form. Please check one of the following
❑Owner ❑ Operator ® Owner & Operator
❑Occupational Licensee ❑ Responsible Party ❑ Voluntary Cleanup Applicant ❑Other:
301 W. Bagdad Street, Suite 250
15. Mailing
Address:
City
Round Rock, TX
Stake
I TX
ZIP
78664I
ZIP + 4
16. Country Mailing Information (if outside usA)
17. E-Mail Address (ifapplfcable)
kbaker@roundrocktexas.gov
18. Telephone Number
( 512 ) 341-3355
19, Extension or Code
20. Fax Number (if applicable)
SECTION III: Regulated Entity Information
21. General Regulated Entity Information (if 'New Regulated Entity" is selected below this form should be accompanied by a permit application)
® New Regulated Entity ❑ Update to Regulated Entity Name ❑ Update to Regulated Entity Information
The Regulated Entity Name submitted may be updated in order to meet TCEQ Agency Data Standards (removal
of or anizational endings such as Inc, LP, or LLC .
22. Regulated Entity Name (Enter name of the site where the regulated action is taking place.)
Heritage Trail East
TCEQ-10400 (02f21) Page 1 of 3
23. Street Address of
the Regulated Entity:
(No PO Boxes}
city
Round
Rock
State
TX
ZIP
78665 ZIP+4
24. County
Williamson
Enter Physical Location Description if no street address is provided.
25. Description to
Physical Location:
The project location runs along the north side of Brushy Creek from Mays Street on the
west end to Old Georgetown Road on the east end.
26. Nearest City State Nearest ZIP Code
Round Rock
TX
78665
27. Latitude (N) In Decimal:
30.521 159
28. Longitude (W) In Decimal:
1 -98.684744
Degrees I
Minutes I
Seconds
Degrees
I Minutes I
Seconds
30
31
16.17
98
41
5.08
29. Primary SIC Code (4 digits) 30. Secondary SIC Code (4 digits) 31. Primary NAICS Code 32. Secondary NAICS Code
5 or 6 digits) (5 or 6 digits)
33. What is the Primary Business of this entity? (Do not repeat the S!C of NAICS descdpoon.)
Parks and Recreation
34. Mailing
Address:
301 W. Bagdad Street, Suite 250
City
I Round Rock
State
TX
I ZIP
78664
ZIP+4
35. E-Mail Address:
kbaker@roundrocktexas.gov
36. Telephone Number 37, Extension or Code 38. Fax Number if a licab!e
( 512 ) 341.3355
1
-
39. TCEQ Programs and ID Numbers Check all Programs and write in the permits/registration numbers that will be affected by the updates submitted on this
form. See the Core Data Form instructions for additional guidance.
❑ Dam Safety
❑ Districts
® Edwards Aquifer
❑ Emissions Inventory Air
❑ Industrial Hazardous Waste
❑ Municipal Solid Waste
❑ New Source Review Air
❑ OSSF
❑ Petroleum Storage Tank
❑ PWS
❑ Sludge
❑ Storm Water
❑ Title V Air
❑ Tires
❑ Used oil
❑ Voluntary Cleanup
❑ Waste Water
❑ Wastewater Agriculture
❑ Water Rights
❑ Other:
SECTION IV: Preparer Information
40' Henry Parker 41. Title: Landscape Architect (RLA)
Name:
42. Telephone Number 43. Ext./Code 44. Fax Number 45. E-Mail Address
( 817 ) 633-0422 ($17) 649-7645 hparker@parkhill.com
SECTION V: Authorized Signature
46. By my signature below, 1 certify, to the best of my knowledge, that the information provided in this form is true and complete, and that I have
signature authority to submit this form on behalfof the entity specified in Section II, Field 6 and/or as required for the updates to the ID numbers
identified in Geld 39.
Company:
City of Round Rock
Job Title:
I City Manager
Name (in Print):
Laurie Hadley
Phone:
( 512 ) 218- 5400
TCEQ-10400 (02121) Page 2 of 3
TCEQ-10400 (02/21) Page 3 of 3
City of Round Rock
ROUND ROCK
TEXAS 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 Laurie
Hadley of the City of Round Rock to represent and act on behalf of the City for
the Heritage Trail East Project.
Consider executing TCEQ Core Data Form regarding the Heritage Trail East
Project.
Type: City Manager Item
Governing Body: City Manager Approval
Agenda Date: 9/9/2022
Dept Director: Rick Atkins, Director of Parks and Recreation
Cost: $0.00
Indexes:
Attachments: LAF - Agent Authorization Form - TCEQ - (Laurie Hadley) -Heritage Trail East, LAF -
TCEQ Core Data Form for the Heritage Trail East Project,
20220829_f-0599_agent_authorization_form, 20220826_f-10400_Core Data Form
Department: Parks & Recreation
Text of Legislative File CM-2022-210
This item is requires as part of the Texas Commission on Environmental Quality (TCEQ) application and
requires City Manager signature. Portions of Heritage Trail East is located over the Edwards Aquifer
Recharge & Contributing zones therefore approval from TCEQ is required prior to bidding and construction.
Heritage Trail East includes a 10-foot wide concrete trail from Mays Street to Georgetown Avenue.
Additional amenities constructed with this phase of trail includes fencing, bridges, and other site amenities,
such as benches and trash bins. Upon ultimate build -out, the Heritage Trail will stretch from Chisholm Trail
Rd to Georgetown Avenue and interpret the history of Round Rock. The programmatic elements of the
project will include historical, educational, and arts & cultural elements, as well as spaces that encourage
community events and development revitalization along the corridor.
This item authorizes Henry Parker with Parkhill to act on behalf of the city for the Heritage Trail East
Project Texas Commission on Environmental Quality (TCEQ) application. Portions of Heritage Trail East is
located over the Edwards Aquifer Recharge & Contributing zones therefore approval from TCEQ is required
prior to bidding and construction.
City of Round Rack Page 1 of 2
Agenda ken! Summary Condnued (CM 2022.210)
Heritage Trail East includes a 10-foot wide concrete trail from Mays Street to Georgetown Avenue.
Additional amenities constructed with this phase of trail includes fencing, bridges, and other site amenities,
such as benches and trash bins. Upon ultimate build -out, the Heritage Trail will stretch from Chisholm Trail
Rd to Georgetown Avenue and interpret the history of Round Rock. The programmatic elements of the
project will include historical, educational, and arts & cultural elements, as well as spaces that encourage
community events and development revitalization along the corridor.
City of Round Rock Page 2 of 2