Loading...
CM-06-04-057aril= Notice of Termination (NOT) for Storm ar- Water Discharges Associated with 1111%,.. Construction Activity under the TPDES Construction General Permit XR150000) Plibummur C(TXR150000) For help completing this application, read the TXR150000 NOI Instructions (TCEQ-20023-Instructions). TCEQ Office Use Only TPDES Permit Number: TXR15•_•_•;•_••- NO GINNumber: •• •• •• •• •• •• .• •. A. TPDES Permit Number: TXR15 X904 B. Construction Site Operator Name: CITY OF ROUND ROCK Mailing Address: 2008 ENTERPRISE DRIVE City: ROUND ROCK Customer Reference Number: CN 600413181 Country Mailing Information (if outside USA) Territory: N/A State: TX Zip Code: 78664 Country Code: N/A Postal Code: N/A Phone Number: 512-218-5555 Extension: N/A Fax Number: 512-218-5563 E-mail Address: C. Project / Site Information Regulated Entity Reference Number: RN 104839030 Name: WESTINGHOUSE WW INTERCEPTOR IMPROV. & WATER TREATMENT OFFSITE WWL IMPROV. Physical Address: N/A Location Access Description: E.of the intersection of 1H35 & Tom Gary Cv.,NE of the intersection of IH13 & FM1431 City: ROUND ROCK County: WILLIAMSON Zip Code: 78681 D. Contact - If the TCEQ needs additional information regarding this termination, who should be contacted? Name: CINDY PRIEN - COMPLIANCE RESOURCES, INC. Title: ADMINISTRATIVE ASSISTANT Phone Number: 512-930-7733 Extension: 221 Fax Number: 512-864-7629 E-mail Address: cindy@complianceresourcesinc.com E. Certification I certify under penalty of law that authorization under the TPDES Construction General Permit (TXR150000) is no longer necessary based on the provisions of the general permit. I understand that by submitting this Notice of Termination, I am no longer authorized to discharge storm water associated with construction activity under the general permit TXR150000, and that discharging pollutants in storm water associated with construction activity to waters of the U.S. is unlawful under the Clean Water Act where the discharge is not authorized by a TPDES permit. I also understand that the submittal of this Notice of Termination does not release an operator from liability for any violations of this permit or the Clean Water Act. Construction Site Operator Representative: Prefix: MR. Last: NUSE Title: CITY MANAGER First: JAMES Middle: R. Suffix: P.E. Signature: Date: If you have q tions on how to fill out this form or about the storm water program, please contact us at (512) 239-4671. Individuals are titled to request and review their personal information that the agency gathers on its forms. They may also have any errors in their information corrected. To review such information, contact us at (512) 239-3282. TCEQ - 20023 (02/03) CM-O'.-6,/d?s7 The completed NOT must be mailed to the following address: Texas Commission on Environmental Quality Storm Water & General Permits Team; MC - 228 P.O. Box 13087 Austin, Texas 78711-3087 Page 1 of 1 DATE: SUBJECT: ITEM: April 3, 2006 City Manager Approval - April 7, 2006 Consider an action by the City Manager to sign a Notice of Termination (NOT) for Storm Water Discharges Associated with Construction Activity under the TPDES General Permit for the Westinghouse WW Interceptor Improvements and Water Treatment Plant Offsite WW Line Improvements project. Department: Engineering & Development Services Staff Person: Ruth Haberman, P.E. Justification: Construction of this project has been completed. The Notice of Termination, signed by the City Manager, must be sent to the Texas Commission on Environmental Quality (TCEQ) to close out the project. Funding: Cost: -0- Source of funds: N/A Outside Resources: Compliance Resources, Inc. Background Information: N/A Public Comment: N/A Request for City Council/City Manager Action 0 City Council © City Manager Submit completed form for all City Manager and City Council approvals. Department Name: Engineering & Development Services For Administration Use ONLY Received: CM'L -0/44 J *CD APR Original Documents R Westinghouse WW Interceptor Improvements Project Name: and Water Treatment Plant Offsite WW Line Contact Person: Latha Kumar/Tiffany Calley ContractorNendor: Project Manager/Resource: Funding Source: Project Coordinator: Ruth Haberman, P.E. Amount Assigned Attorney: Account Number: Council or City Manager Approval Date: Blue Sheet Wording 4/7/2006 $0.00 Consider an action by the City Manager to sign a Notice of Termination (NOT) for Storm Water Discharges Associated with Construction Activity under the TPDES General Permit for the Westinghouse WW Interceptor Improvements and Water Treatment Plant Offsite WW Line Improvements project. Finance Information Is Funding Required? Q Yes n No 0 0 Initial Construction Contract Construction Contract Amendment # Change Order Change in Quantity Unforeseen Circumstances Initial Professional Services Agreement Supplemental Professional Svcs. Ai # QPurchasing/Service Agreement Finance Approval Finance JFinance Purchasing 0Budget Purchase Order Item(s) to be purchased: Amount Other (Please clearly identify action on lines below) City Manager's signature on the Notice of Termination. Date Date Date Date Reauired for Submission of ALL City Council and City Manager Items Project Mgr. Signature: Dept. Director Signatur City Attomey Signature*: City Manager Signature: e7. Date: itq, C. Date: Date: Is required for all items. 4 OL Updated 2/18/08 Request for City Council/City Manager Action City Council 0 City Manager Submit completed form for all City Manager and City Council approvals. For Administration Use ONLY Received: Tag # Original Documents Received: Department Name: Engineering & Development Services Contact Person: Latha Kumar/Tiffany Calley Project Manager/Resource: Project Coordinator: Ruth Haberman, P.E. Assigned Attorney: Council or City Manager Approval Date: Blue Sheet Wording Westinghouse WW Interceptor Improvements Project Name: and Water Treatment Plant Offsite WW Line ContractorNendor: Funding Source: Amount: Account Number: 4/7/2006 $0.00 Consider an action by the City Manager to sign a Notice of Termination (NOT) for Storm Water Discharges Associated with Construction Activity under the TPDES General Permit for the Westinghouse WW Interceptor Improvements and Water Treatment Plant Offsite WW Line Improvements project. Finance Information Is Funding Required? 0 Yes Q No 0 0 0 CI Purchasing/Service Agreement Finance Approval EJFinance Finance EJPurchasing El Budget Initial Construction Contract Construction Contract Amendment # Change Order Change in Quantity Unforeseen Circumstances Initial Professional Services Agreement Supplemental Professional Svcs. Al # Purchase Order Item(s) to be purchased: Amount Other (Please clearly identify action on lines below) City Manager's signature on the Notice of Termination. n/a L. Olsen N/A HB N/A CYD Date 4/5/2006 Date Date 4/5/2006 Date 4/4/2006 Required for Submission of ALL City Council and City Manager Items Project Mgr. Signature: Date: Dept. Director Signature: Date: City Attorney Signature*: Date: City Manager Signature: Date: x Legal Approval is required for all items. Updated 2/16/06