CM-2015-916 - 10/9/2015ek, ..1
Agent Authorization Form
For Required Signature
Edwards Aquifer Protection Program
Relating to 30 TAC Chapter 213
Effective June 1, 1999
of City of Round Rock
Corporation/Partnership/Entity Name
have authorized Israel Ramirez, P.E.
Print Name of Agent/Engineer
of Randall Jones Engineerino 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.
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.
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.
Ok4-ZC)/"/6,
TCEQ-0599 (Rev.04/01/2010)
Page 1 of 2
SIGNATURE PAGE:
Applicant' Signature
THE STATE OF Texas §
County of WL I..l i A §
1.0
1�1� l�js
Date
BEFORE ME, the undersigned authority, on this day personally appeared known
to me to be the person whose name is subscribed to the foregoing instrume t, and acknowledged to
me that (s)he executed same for the purpose and consideration therein expressed.
GIVEN under my hand and seal of office on this T day of&ge�,45.
SARA LEIGH WHITE NOTARY PUBLIC
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R* Y*;•• MY COMMISSION EXPIRES
July 11, 2016 Typed or Print Name of Notary
MY COMMISSION EXPIRES: 1 ZD
TCE"599 (Rev.04/01/2010) Page 2 of 2
AV City of Round Rock
ROUND ROCK
TEXAS Agenda Item Summary
Agenda Number:
Title: Consider executing TCEQ "Agent Authorization Form For Required
Edwards Aquifer Protection Program Relating to 30 TAC Chapter 213"
authorizing Israel Ramirez to represent and act on behalf od the City
regarding the Arterial "H" 16 -inch Waterline Project.
Type: City Manager Item
Governing Body: City Council
Agenda Date: 10/9/2015
Dept Director: Michael Thane, Director of Utilities and Envorinmental Services
Cost:
Indexes:
Attachments: LAF - TCEQ Edwards Aquifer Protection Program -
(00343390xA08F8).pdf, AgentAuth_RandallJones_10.2.15.pdf
Department: Utilities and Environmental Services
Text of Legislative File CM -2015-916
Consider executing TCEQ "Agent Authorization Form For Required Edwards Aquifer
Protection Program Relating to 30 TAC Chapter 213" authorizing Israel Ramirez to
represent and act on behalf od the City regarding the Arterial "H" 16 -inch Waterline
Project.
The City is planning to construct a 16 -inch waterline along the future Arterial H
roadway. This project will commence at C.R. 175 and Arterial H and extend easterly
along the future roadway into the Mayfield Ranch subdivision.
The City is required by the Texas Commission on Environmental Quality (TCEQ) to
obtain an Organized Sewer Collection System (SCS) approval from TCEQ prior to
conducting work over the Edwards Aquifer Recharge Zone (EARZ). The Arterial H
16 -inch Waterline Project is located over the EARZA and as a result, the City must
address the EARZ requirements. By the City executing the Agent Authorization Form,
this will authorize the City's consultant, Israel Ramirez, P.E., of Randall Jones &
Associates Engineering, Inc. to act as an agent to the City and submit the application
for approval of the Water Pollution Abatement Plan Exemption Request for this project.
City of Round Rock Page 1 Printed on 9002015