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CM-11-10-213Item Caption: Approval Date: C!1-(I10Zi3 RECEIVED OCT 19 2011 City Manager Approval Form Consider executing a Duly Authorized Representative Designation Form required by the Texas Commission on Environmental Quality (TCEQ) for the Deeowood Recycling Center October 21, 2011 Department Name: Utilities and Environmental Services Department Project Manager: Michael Thane Assigned Attorney: Steve Sheets Item Summary: The City's Recycling Center, 310 Deepwood Drive, is covered by a general Storm Water Permit. The permit language has changed therefore the City must submit a Notice of Intent (N01) in order to be covered under the new permit. This permit requires that the signatory for the NOI and other various reports, be as those described in Texas Administrative Code (TAC) 305.44, are signed by a duly authorized representative as specified by TAC 305.128. Signing of this Duly Authorized Representative Form, will authorize the positions of Environmental Services Supervisor and the Pretreatment Compliance Specialist to sign all required documents for the Recycling Center location, as required by the Storm Water Permit. No. of Originals Submitted: 2 Project Name: Cost: Source of Funds: Deepwood Recycling Center N/A Select Source Fund Source of Funds (if applicable): Select Source Fund Account Number: Finance Director Approval: Cheryl Delaney Date: 10/18/11 Department Director Approval: Michael Thane Date: 10/16/11 **Electronic signature by the Director is acceptable. Please only submit ONE approval form per item. ** CIP Budget Purchasing © ID Accounting 1J N/A OK N/A OK N/A OK N/A OK ITEMS WILL NOT BE PLACED ON THE COUNCIL OR CM AGENDA W/OUT PRIOR FINANCE AND/OR LEGAL APPROVAL REV. 6/20/11 DULY AUTHORIZED REPRESENTATIVE DESIGNATION FORM Company Name: City of Round Rock Facility Address: Deepwood Recycling Center Permit # 310 Deepwood Drive, Round Rock, TX 78664 Storm Water Permit # TXR05M949 Authorized Representative/Title: Environmental Services Supervisor Alternate Representative/Title: Pretreatment Compliance Specialist TAC 305.44 Signatory Requirements to Applications: (a) All applications shall be signed as follows. (3) For a municipality, state, federal or other public agency, the application shall be signed by either a principal executive officer or a ranking elected official. For purposes of this paragraph, a principal executive officer of a federal agency includes the chief executive officer of the agency, or a senior executive officer having responsibility for the overall operations of a principal geographic unit of the agency (e.g., regional administrator of the EPA). (b) A person signing an application shall make the following certification: "I certify under penalty of law that this document and all attachments were prepared under my direction of supervisor in accordance with a system designed to assure that qualified personnel properly gathered and evaluated 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 a fine and imprisonment for knowing violations." TAC 305.128 Signatories to Reports (a) All reports required by permits and other information required by the executive director shall be signed by a person described in 305.44(a) of this title (relating to Signatories to Applications) or by a duly authorized representative of that person. A person is a duly authorized representative only if: (1) The authorization is made in writing by a person described in 305.44(a) of this title (relating to Signatories to Applications); (2) The authorization specified either an individual or a position having responsibly for the overall operation of the regulated facility or activity of for environmental matters for the applicant, such as the position of the plant manager, operator of a well or well field, environmental manager, or a position of equivalent responsibility. (A duly authorized representative may thus be either a named individual or any individual occupying a named position); and (3) The written authorization is submitted to the executive director. I hereby authorize the above named position(s) to fulfill the signatory requirements as set forth in TAC 305.44. Signature: Name: Title: i Date: /e —t=7[A,i9/eteDadv.6