CM-06-04-059WIWI Notice of Termination (NOT) for Storm
V. :Water Discharges Associated with
plow Construction Activity under the TPDES
flatill
TCEQ Office Use Only
TPDES Permit Number: TXR15•• •• •• •• ••- NO
GIN Number: •• •• •• •• •• •• •• ••
Construction General Permit (TXR150000)
TCEQFor help completing this application, read the TXR150000 NOI Instructions (TCE0-20023-Instructions).
A. TPDES Permit Number: TXR15 1488
B. Construction Site Operator Customer Reference Number: CN CN6004131
Name: City of Round Rock
Mailing Address: 2008 ENTERPRISE DRIVE
City: ROUND ROCK State: TX Zip Code: 78664
Country Mailing Information (if outside USA) Territory: N/A Country Code: N/A Postal Code: N/A
Phone Number: (512) 218-5555 Extension: N/A Fax Number: (512) 218-5563
E-mail Address: rhabermaneround-rock.tx.us
C. Project / Site Information Regulated Entity Reference Number: RN 104449954
Name: CITY OF ROUND ROCK DOWNTOWN STREETS PHASE 1 GO BOND 2002
Physical Address: N/A
Location Access Description: ON PECAN & LEWIS STS ADJACENT TO VETERANS PARK
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: N/A Fax Number: (512) 218-5563
E-mail Address: rhabermantround-rock.tx.us
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 Suffix: P.E.
Title: CITY . ANAGER
'y
Signature: \ Date: '''7 ` / -O
If you have q
Individuals are
also have any
TCEQ - 20023 (02/03)
ions 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
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
Page 1 of 1
Request for City Council/City Manager Action
1 City Council ED City Manager
For Administration Use ONLY
Receiv
±1.D1e-cF
Tag #
r -
Submit completed form for all City Manager and City Council approvals.
Original Documents Received:
Department Name: Engineering & Development Services Project Name: Downtown Streets Phase 1
Contact Person: Latha Kumar/Tiffany Calley ContractorNendor:
Project
Manager/Resource: Funding Source:
Project Coordinator: Ruth Haberman, P.E. Amount: $0.00
Assigned Attorney: Account Number:
Blue Sheet Wording
Council or City Manager Approval Date: 417/2006
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 City of Round Rock Downtown Streets Phase 1 GO Bond 2002 project.
Finance Information
Is Funding Required? Q Yes Q No
Finance Approval
Finance
ElFinance
El Purchasing Date
El Budget
Initial Construction Contract
Construction Contract Amendment #
Change Order
Change in Quantity
Unforeseen Circumstances
Initial Professional Services Agreement
QSupplemental Professional Svcs. Al #
Purchasing/Service Agreement
Purchase Order
Item(s) to be purchased:
Amount
Other (Please clearly identify action on lines below)
City Managers signature on the Notice of Termination.
Date
Date
Date
Reauired for Submission of ALL City Council and City Manaaer Items
Project Mgr. Signature: _ �
Dept. Director Signature: .,� �l"g Q... t'. F, Date: 443 /o 6
City Attorney Signature*: ; • Date: 7 ( IX
'' V
City Manager Signature: Date: `" - L
2l
Date:
01/7/06
val is required for all items.
Updated 2/16/06
Request for City Council/City Manager Action
El City Council J City Manager
For Administration Use ONLY
Received:
Tag #
Submit completed form for all City Manager and City Council approvals.
Department Name: Engineering & Development Services
Contact Person: Latha Kumar/Tiffany Galley
Project
Manager/Resource:
Project Coordinator: Ruth Haberman, P.E.
Assigned Attorney:
Blue Sheet Wording
Council or City Manager Approval Date:
Original Documents Received:
Project Name: Downtown Streets Phase 1
ContractorNendor:
Funding Source:
Amount:
Account Number:
4/7/2006
$0.o0
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 Downtown Streets Phase 1 GO Bond 2002 project
Finance Information
Is Funding Required? Q Yes Q No
0
Supplemental Professional Svcs. Ai #
Purchasing/Service Agreement
Purchase Order
Initial Construction Contract
Construction Contract Amendment #
Change Order
Change in Quantity
Unforeseen Circumstances
Initial Professional Services Agreement
Item(s) to be purchased:
Amount
Other (Please clearly identify action on lines below)
City Manager's signature on the Notice of Termination.
Finance Approval
Finance n/a L. Olsen Date 4/5/2006
Finance Date
OPurchasing N/A HB Date 4/5/2006
Budget N/A CYD 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:
Legal Approval is required for ell items.
Updated 2/16106
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 City of Round Rock Downtown
Streets Phase 1 GO Bond 2002 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