CM-06-09-175Notice of Intent (NOI) for Storm Water
Discharges Associated with Industrial Activity
er) under TPDES General Permit (TXR050000)
TCEQ Office Use Only
Permit No.:
RN:
CN:
Sign up now for on line NOI at http://wvcw.teeti.state.tx.usinermitting/steers/steers.html
Did you know you can pay on line? Go to www.tcen.state.tx.us/cl'as
Select Fee Type: GENERAL PERMIT INDUSTRIAL STORM WATER DISCHARGE NOI APPLICATION
Application Fee: You must pay the S100 Application Fee to TCEQ for the application to be considered complete.
How did our this fee?
Mailed: Check/Money Order No.: Name Printed on Check:
EPAY: Voucher No.: 15 2. 2 0
IMPORTANT
•Use the attached INSTRUCTIONS when completing this form.
•After completing this form, use the attached CUSTOMER CHECKLIST to make certain all items are complete and accurate.
•Missing, illegible, or inaccurate items may delay final acknowledgment or coverage under the general permit.
Renewal of General Permit
Is this NOI being submitted to continue an ACTIVE authorization under a reissued general permit?
O Yes If Yes, what is the permit number issued by TCEQ? Permit No.: TXR05M949
❑ No If No, a new permit number will be issued.
Is the Payment Voucher copy attached? 0 Yes
A. OPERATOR (applicant)
1. If the applicant is currently a customer with TCEQ, what is the Customer Number (CN) issued to this entity? CN
2. What is the full Legal Name of the applicant?
City of Round Rock
(The legal name must be spelled exactly as filed with the Texas Secretary of State, County, or in the legal document forming the entity.)
3. What is the applicant's mailing address as recognized by the US Postal Service?
Address: I Suite No./Bldg. No./Mail Code:
2008 Enterprise Drive
City: Round Rock 1
Country Mailing Information (if outside USA)Statte: Texas
4. Phone No.: ( 512 ) 2185559 I Extension:
5. Fax No.: (512 ) 3413316
6. Indicate the type of Customer:
0 Individual 0 Sole Proprietorship-D.B.A.
0 Corporation Federal Government
State Government County GovernmentOther:
7. Independent Operator: Yes Q No (If governmental entity, subsidiary, orpart of a larger
8. Number of Employees: 0-20 21-100• g corporation,check "No".)
n , n101-250; n251-500; or 0501 or higher
9. Customer Business Tax and Filing Numbers (This item is not applicable to Individuals, Government, GP or Sole Proprietor.)
REQUIRED for Corporations and Limited Partnerships
State Franchise Tax ID Number: i Federal Tax ID:
TX SOS Charter (filing) Number: DUNS Number (if known):
B. BILLING ADDRESS
The Operator is responsible for paying the annual fee. The annual fee will be assessed to permits active on September 1 of each year. TCEQ will
send a bill to the address provided in this section. The Operator is re ponsible for terminating the permit when it is no longer needed.
Is the billing address same as the Operator Address? rUYes, go to Section C.F.-No, fill out Section B
1. Billing Mailing Address: I Suite No./Bldg. No./Mail Code:
2008 Enterprise Drive
1 ZIP Code: 78684
Country Code: Postal Code:
E-mail Address: tracyh@round-rock.txus
❑Limited Partnership
3 eneral Partnership
ity Government
City: Round Rock 1 State: Texas
2. Country Mailing Information (if outside USA). Territory:
3. Billing Contact (Attu or C/O):
4. Phone No.: ( 512 ) 2185559
5. Fax No.: ( 512 ) 3413316
1 ZIP Code: 78664
Country Code: Postal Code:
Extension:
E-mail Address: tracytr@round-rock.tx.us
TCEQ-10382 (08/09/2006)
Cm- O -C6i-i -t
Page 1
C. APPLICATION CONTACT
If TCEQ needs additional information regarding this application, who should be contacted?
1. Name:
Tracy Herring
2. Phone No.: ( 512 ) 2185559
3. Fax No.: ( 512 ) 3413316
Title:
Environmental Services Supervisor
Company:
City of Round Rock
Extension:
E-mail Address: tracyh@round-rock.tx.us
D. REGULATED ENTITY (RE) INFORMATION ON PROJECT OR SITE
1. TCEQ Issued RE Reference Number (RN) (if available):
2. Name of Project or Site (the name as known by the community where this facility/project is located):
City of Round Rock Recycling Center
(example: phase and name of subdivision or name of project that's unique to the site)
3. Physical Address of Project or Site: (enter in spaces below)
Street Number:
City:
310
Street Name:
Deepwood Drive
Round Rock
ZIP Code:
78664
County (Counties if>1):
Williamson
4. If no physical address (Street Number & Street Name), provide a written location access description to the site:
(Ex.: phase 1 of Woodland subdivision located 2 miles west from intersection of Hwy 290 & IH35 accessible on Hwy 290 South)
5. Latitude: Deg 30 Min 30 Sec 13
Longitude: Deg 97 Min 41 Sec 58
W
6. What is the primary business of this entity? In your own words, briefly describe the primary business of the Regulated Entity:
(Do not repeat the SIC and NAICS code)
Drop Off Recycling Center for residential users
7. What is the mailing address and contact information for the regulated entity?
Is the RE mailing address the same as the Operator? ]Operator ONo, provide the address
Street Number:
City:
Street Name:
E. GENERAL CHARACTERISTICS
State:
ZIP Code:
1. I certify that the project/site is not located on Indian Country Lands?
If No, you must obtain authorization through EPA, Region VI.
2. Is this NOI being submitted due to a change in Operator? 0 Yes 0 No, this is for a new discharge
3. What is the SIC Code that is within the range listed and corresponds with the selected Activity or Sector in the General Permit?
Primary SIC Code: 5093 Secondary SIC Code:
4. What is the Sector that applies to the industrial activity at your facility? (It must correspond with the SIC Code provided above.)
RSector A
Sector B
}Sector C
❑Sector D
OSector U
Sector E
Sector F
Sector G
O Sector H
❑Sector Z
O Sector I
O Sector J
❑Sector K
❑ Sector L
Sector M
ID Sector N
❑ Sector 0
O Sector P
E3Yes D No
Sector Q
Sector R
❑Sector S
❑Sector T
['Sector V
❑ Sector W
Sector X
Sector Y
❑ Sector AA
❑ Sector AB
Sector AC
Sector AD
5. If applicable, what is the Activity Code that corresponds with the Sector in the General Permit?
O HZ OLF OSE OTW OAD
If Activity Code AD is selected, a copy of the letter from TCEQ requiring coverage under this general permit through this activity code must be
included with this Notice of Intent form or coverage may be denied.
6. Discharge Information
a. What is the name of the first water body to receive the storm water runoff or potential runoff from the site?
Lake Creek
b. What is the segment number(s) of the classified water body(s) that the discharge will eventually reach?
c. Is the discharge into an MS4? DYes ONo
If Yes, what is the name of the MS4 Operator?
Note: The general permit requires you to send a copy of the NOI to the MS4 Operator.
7. Is the discharge or potential dischar a within the Recharge Zone, Contributing Zone, or Contributing Zone within the Transition
Zone of the Edwards Aquifer? +� Yes ONo
If the answer is Yes, please note that a copy of the agency approved Plan required by the Edwards Aquifer Rule (30 TAC Chapter
213) must be included in the Storm Water Pollution Prevention Plan.
TCEQ-10382 (08/09/2006)
Page 2
F. CERTIFICATION
Check "Yes" to the certifications below. Failure to indicate "Yes" to ALL items may result in denial of coverage under the general permit.
I certify that I have obtained a copy and understand the terms and conditions of the general permit TX050000. El Yes
I certify that the activities at this site qualify for coverage under the general permit TX050000. p
Yes
I understand that a Notice of Termination (NOT) must be submitted when this authorization is no longer needed. El Yes
I understand that permits active on September 1st of each year will be assessed an Annual Water Quality Fee. U Yes
I certify that a Storm Water Pollution Prevention Plan has been prepared and implemented as required in the general permit. QYes
Operator Certification:
3om R. ISI t,L' L (Ji
Typed or printed name
YYl
Title (111(1°fr
certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a syslcm
designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons
who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my
knowledge and belief, true, accurate, and complete. I am aware there are significant penalties for submitting false information, including the
possibility of fine and imprisonment for knowing violations.
I further certify that I am authorized under 30 Texas Administrative Code §305.44 to sign and submit this document, and can provide
documentation in proof of such authorization upon request.
Signature:
(Use blue ink)
TCEQ-10382 (08/09/2006)
Date: 61111 aooc.0
Page 3
TCEQ ePay
TEXAS COMMISSION ON ENVIRONMENTAL QUALITY
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Print this voucher for your records. If you are sending the TCEQ hardcopy documents related to this
payment, include a copy of this voucher.
—Transaction Information
Voucher Number:
Trace Number:
Date:
Payment Method:
Amount:
Fee Type:
ePay Actor:
Actor Email:
IP:
15220
582EA000013253
08/17/2006 02:08 PM
CC - Authorization 0000049401
$100.00
General Permit Water Discharge Application
Tracy Herring
tracyh@round-rock.tx.us
209.184.6.2
—Payor Information
Payor Name:
Company:
Address:
Phone:
Tracy Herring
City Of Round Rock
78664
512-218-5559
-Site Information
Site Name:
Site Address:
Site Location:
CITY OF ROUND ROCK RECYCLING CENTER
310 DEEPWOOD DRIVE, ROUND ROCK, TX 78664
310 DEEPWOOD DRIVE
—Customer Information
Customer Name:
Customer Address:
TRACY HERRING
2008 ENTERPRISE DRIVE, ROUND ROCK, TX 78664
-Other Information
Program Area ID:
Comments:
permit TXR050000
TXR05M949
Continued coverage under Storm Water Permit TXR05M949 - for new general
Close
haps://www6.tceq.state.tx.us/epay/index.cfm?fuseaction=receipts. voucher detail&userid=1332&pmt id= 1... 8/17/2006
DATE: August 22, 2006
SUBJECT: City Manager Approval - September 1, 2006
ITEM: Consider an action by the City Manager to sign a Notice of
Intent (NOI) for Storm Water Discharges Associated with
Industrial Activity under TPDES General Permit
(TXR050000) for the Recycling Center located at 310
Deepwood Drive.
Department: Environmental Services
Staff Person: Tracy Herring
Justification:
The City's Recycling Center is currently covered under TPDES multi -sector
storm water general permit number TXR05M949. The TCEQ has approved a
new general permit (TXR0000) which has additional requirements that will
be applicable to this location. Application for coverage under the new permit
is required by submitting a Notice of Intent (NOI). The NOI must be signed
by the City Manager.
Funding:
Cost: -0-
Source of funds: N/A
Outside Resources: N/A
Background Information:
The Recycling Center, located at 310 Deepwood Drive, has had a storm
water permit since 2001. A Storm Water Pollution Prevention Plan (SWP3) is
in place and will be updated in accordance with the new regulations.
Public Comment: N/A