CM-06-04-058_ Notice of Termination (NOT) for Storm
41 Water Discharges Associated with
Construction Activity under the TPDES
urolblirit Construction General Permit (TXR150000)
MEd For help completing this application, read the TXR150000 NOI InstructionsCEQ-20023-Instructions .
R )
TCEQ Office Use Only
TPDES Permit Number: TXR15•_•_•_•_• - NO
GIN Number: •• •• •• •• •• •• •• ••
A. TPDES Permit Number: TXR15 K173
B. Construction Site Operator
Name: City of Round Rock
Customer Reference Number: CN CN6004131
Mailing Address: 2008 ENTERPRISE DRIVE
City: ROUND ROCK
Country Mailing Information (if outside USA) Territory: N/A
Phone Number: (512) 218-5555 Extension:
E-mail Address: rhabermant round-rock.tx.us
State: TX Zip Code: 78664
Country Code: N/A Postal Code: N/A
N/A Fax Number: (512) 218-5563
C. Project / Site Information Regulated Entity Reference Number: RN 104512587
Name: CITY OF ROUND ROCK EAST TRANSMISSION LINE PHASE II
Physical Address: N/A
Location Access Description: ON NE OF INTER OF OLD SETTLERS BLVD & FM 1460
City: ROUND ROCK County: WILLIAMSON
Zip Code: 78664
D. Contact - If the TCEQ needs additional information regarding this termination, who should be contacted?
Name: Ruth Haberman. P.E. Title: Engineer
Phone Number: (512) 218-6605 Extension:
E-mail Address: rhabermanaround-rock.tx.us
N/A Fax Number: (512) 218-5563
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. First: JAMES Middle: R.
Last: NUSE
Title: CITY MANAGER
Suffix: P.E.
Signature:
If you have
Individuals ar
Date: 1-/- 17- C
tions on how to fill out this form or about the storm water program, please contact us at (512) 239-4671.
ntitled 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.
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
TCEQ - 20023 (02/03) Page 1 of 1
ens-o1,-rsy-Os g
DATE: April 3, 2006
SUBJECT: City Manager Approval - April 7, 2006
ITEM: 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 City of Round Rock East
Transmission Line Phase II 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: N/A
Background Information: N/A
Public Comment: N/A
Request for City Council/City Manager Action
[01 City Council 0 City Manager
Submit completed form for all City Manager and City Council approvals.
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
For Administration U
CM Y V i
Receiv .
Tag A 1,z "k
Original Documents Received:
Project Name: East Transmission Line Phase II
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 City of Round Rock East Transmission Line Phase II project.
Finance Information
Is Funding Required?
Yes
No
Initial Construction Contract
Construction Contract Amendment #
Change Order
Change in Quantity
Unforeseen Circumstances
Initial Professional Services Agreement
Supplemental Professional Svcs. Al #
Purchasing/Service Agreement
EDI Purchase Order
Item(s) to be purchased:
Finance Approval
Finance
Finance
Purchasing
0Budget
Amount
Other (Please clearly identify action on lines below)
City Manager's signature on the Notice of Termination.
Date
Date
Date
Date
Required for Submission of ALL City Council and CitvMVlanager Items
Project Mgr. Signature: vu Date: //Oh
Dept. Director Signature -
City Attorney Signature*:
City Manager Signature:
P -E Date: 4-13/e
Date: ti/o�
Date:
vat is required for all items.
Updated 2/16/06
Request for City Council/City Manager Action
ID City Council J City Manager
For Administration Use ONLY
Received:
Tag #
Submit completed form for all City Manager and City Council approvals.
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:
Blue Sheet Wording
Council or City Manager Approval Date:
Project Name: East Transmission Line Phase H
ContractorNendor:
Funding Source:
Amount:
Account Number:
4/712006
$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 City of Round Rock East Transmission Line Phase 11 project.
Finance Information
Is Funding Required? 0 Yes 0 No
Initial Construction Contract
Construction Contract Amendment #
Change Order #
Change in Quantity
Unforeseen Circumstances
Initial Professional Services Agreement
Supplemental Professional Svcs. AI #
Purchasing/Service Agreement
Purchase Order
Item(s) to be purchased:
Amount
EJ Other (Please clearly identify action on lines below)
City Managers signature on the Notice of Termination.
Finance Approval
ElFinance n/a L. Olsen Date
Finance Date
Purchasing N/A HB Date
Budget N/A CYD Date
4/5/2006
4/5/2006
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:
* Legal Approval is required for ell Items.
Updated 2/16/06