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CM-11-12-241C,v\- -JL- /q 1 RECEIVED NOV 3 0 2011 MDSE oar, As MUM 11109111TY City Manager Approval Form Consider executing TCEQ Discharge Monitoring Report (DMR) Address and Signatory Authority Form Item Caption: regarding the Brushy Creek Regional Wastewater Plant - East Plant. Approval Date: December 2, 2011 Department Name: Utilities and Environmental Services Department Project Manager: Michael Thane Assigned Attorney: Steve Sheets Item Summary: In December 2009, the Cities of Round Rock, Austin and Cedar Park purchased the Brushy Creek Regional Wastewater System (BCRWWS) from the Lower Colorado River Authority (LCRA). Following the purchase of the BCRWWS, the Texas Commission on Environmental Quality (TCEQ) wastewater permits were transferred from the LCRA/Brazos River Authority (BRA) to the three Cities. This form, which the three Cities have all agreed to, authorizes the BRA to sign and submit the monthly Discharge Monitoring Reports (DMRs) to the TCEQ. The BCRWWS consists of two treatment plants, known as the East Treatment Plant and West Treatment Plant. This form is for the West Treatment Plant. No. of Originals Submitted: Project Name: Cost: Source of Funds: Brushy Creek Regional Wastewater System Select Source Fund Source of Funds (if applicable): Select Source Fund Account Number: Finance Director Approval: S. Carter for Cheryl Delaney Department Director Approval: Michael Thane Date: 11/29/2011 Date: 11/29/2011 **Electronic signature by the Director is acceptable. Please only submit ONE approval form per item. ** CIP © L1 Budget © Purchasing ® Accounting © i:i 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 1 TEXAS COMMISSION ON ENVIRONMENTAL QUALITY Discharge Monitoring Report (DMR) T®°-- Address and Signatory Authority Form OIf you have questions about completing this form, please contact the Compliance Monitoring Team at 512-239-2545. Individuals are entitled 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 512-239-2545. Permit information::• • / 9i{D TPDES PERMIT NUMBER (ifaplicable): t,1Q 00 l 0 2 6 4/ coa EPA ID NUMBER: TX PERMITTEE AND/OR FACILITY NAME: 0.5117 c(p47K (t7L)' l�Pg1t"7l I'lirerr��. it DMR MAIUNG ADDRESS: (If different from your primary mailing address stated on the pemnit) (Street Address) FfelIfill t (City, State and Zip Code) Note: If your primary mailing address has changed, please submit the revised address in writing to the Applications Review and Processing Team (MC 148). Please call 512-239-4671 to request the form for this purpose. a$� nolo, lnforlrlation ��...i:`r`'-u'..��:>u....`�;{�+ u 's'.+.,-�.. � };��`.:r.. r � �`,..3'� �-,p�_'�`i' �.r.......t3�rn._+3+L'� _..r.,,-..�_ INDIVIDUAL(S) DELEGATED AUTHORITY TO SIGN DISCHARGE MONITORING REPORTS (DMRs): (Other than person delegating authority- Delegation of signatory authority must meet the requirements in 30 Tex. ADMIN. Cone 305.128. See reverse of this form for rule citation.) y%c /7ad fry(Name) i '� r�t%/Sir,Aa-�1v - C/ y ' te) / �l %nrx �t[U? e� 71041'' /Inl /I fe (Name) PERSON TO CONTACT BY PHONE: � �1 '4. /--/e,t0 CY t��' l Ur'tk' l'y a.v'a7/ 5.7,41 -11:471P --da- / ff (Name) 2sy 7/33!,`((TTill !02 A-4-0,14 ,14 (c/ ,(Phone Number) 1��1pa !j 4-aes, 00-5; (E-mail Address)..../ RESPONSIBLE CORPORATE OFFICER, GENERAL PARTNER, PROPRIETOR, PRINCIPLE EXECUTIVE OFFICER, OR RANKING ELECTED OFFICIAL: (Individual listed below is a person defined in 30 Tex. ADMIN. CODE 305.44(a). See reverse of this form for rule citation,) S-f-eii - nJorw oo d (Printed name) LJ (Title) 111€* certify that I am a RESPONSIBLE CORPORATE OFFICER, GENERAL PARTNER, PROPRIETOR, PRINCIPAL EXECUTIVE OFFICER, OR RANKING ELECTED OFFICIAL for the above -referenced regulated facility, and I therefore have authority under 30 TAC 305.44 to sign reports. I certify that signatory authority for Discharge Monitoring Reports has been delegated to the above-named individual(s) in accordance with applicable procedures, consistent with 30 TAC 305.44 and 305.128. 1 also certify that the above-named individual(s) are either individuals or a position having responsibility for the overall operation of the regulated facili • • = environmen - matters of the regulated facility. !further certify that I can provide documentation :::: u —� "E: DATE: c°7:5--tr— PHONE NO.: £ S(1) 24 8 —s(-410 PLEASE RETURN COMPLETED FORM TO: TCEQ / Compliance Monitoring Team (MC 224) Enforcement Division P.O. Box 13087 Austin, Texas 78711-3087 TCEQ-20431 (Rev. 02-19-08) 1 of 2 elvl—ll—(Z—Z�I