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y 14, 2003
-ek Brothers Construction, Inc.
Attn: Pat or Joe Marek
2112 Southwood Drive
College Station, TX 77840
Re: State Bank, Longmire
Dear Mr. Marek,
Attached is the Notice of Intent (NOI) that you need to sign for the State Bank,
Longmire project. Once signed you should attach the $100 fee and mail to TCEQ.
Please keep a copy of this NOI for your records and forward a copy to Spencer
Thompson. at the City of College Station, ( Development Services).
Once this is done you will be in compliance with TCEQ filing rules.
If you have any questions please give us a call.
Sincerely,
n,\
Veronica 7.B kMorgi LL1P
Managing Partner
Cc: Brad Cutright
M Notice of Intent (NOI) for Storm WaterDischarges TCEQ Office Use Only
j �� Associated with Construction Activity under the TPDES Permit Number: TXR15•_•_ _ NO
TPDES Construction General Permit (TXR150000) GIN Number: •_•_•_•_•_•_•_••
„C
VGQ For help oompleting this application, read the TXR160000 NOI Instructions
(TCEQ-20022-Instructions).
A. Construe ton Sife Operator ❑New ❑No Change ,Customer Reference Number. CN
Name: rr� (l7P O �XT I % P (S r �Yl�l n'IC -i —) , Inc
MailingAddress:raIIq S�l.l-1-1�1WC)r0 LLVe- City:(,yJle('wIr�Stale Zip Code: ��kU�
CountryMailing ir� ormation (if outside USA) Territory:_Country ode: Postal Code:
Phone Number: n ICI " UICI �:� - SS (DO Extension: Fax Number: q �C1 � (r,C9 (fi-' �5G,9
E-mail Address: M Ox rJ -c-i- ' LLG CQCL I , C' rn
Type of Operator: ❑ Individual ❑ Sole Proprietorship - D.B.A. ❑ Partnership 0 Corporation ❑ Federal Government
❑ Stale Government ❑ County Government ❑ City Government ❑ Other.
Independent Operator? '®,Yes ❑ No Number of Employees: IAO-20 ❑ 21-100 ❑ 101-250 ❑ 251500 ❑ 501 or higher
Federal Tax ID: `{'Z.�i9 2�I 2 State Franchise Tax ID Number.. I., d2 L1U'ZC12 �9 DUNS Number:
B. Sitting Address
Name: 1`il( fe L -�Xr-Iht' F CJY-)S+-ruCA-I�n 1 vac .
Mailing Address:.r�Il;� `_ �tl'it,%UCC� DC(VQ. city:,'���PgT ��-�StateT�_ZipCode:%�74t10
Country Mailing Information (if outside USA) Territory: Country Code: Postal Code:
C. Project I Site Information ❑New []No Change Regulated Entity Reference Number: RN
Name:
Mailing Address: a U3- (.-) - nn l V£. City: UC ' 1i-a.f lD r) State:TC Zip Coder
Physical Address: awe t0205 Zip Code:
Location Access Description:
Latitude:-:'�"D-a-' L. r N Longitude:Cq(D •N' S� " W Degrees (•), Minutes ('), and Seconds (")
Latitude: LoIgii'tulde: - Decimal Form
tandard Industrial Classification (SIC) code: I Sys Also, describe the constructsgl activity at this site (do not repeat the SIC code):
l rl�-Ffu n o<-C� i-��.., hnririnc t ((� (CCr�rn=r- c�li Cs�v�s-i--rttc+�<�r,�
Has a storm water pollution prevention plan been prepared as bpecified in the general permit (TXR150000)? MYes ❑ No
Estimated area of land disturbed (to the nearest acre):Is the project / site located on Indian Country Lands? ❑ Yes Of No
Does this project I site discharge storm water Into a municipal separate storm sewer system (MS4)? tp"fes ❑ No
If yes, provide the name of the MS4 operator.- Lk 1 'h(' f h i l t C` ( 3 i1ir. Ct I )n
Provide the name or segment number of the water body that receives storm water from this project / site:1Pr' ( ye P �- —T %i
D. Contact- If the TCEQ needs additional information regarding this application, who should be contacted?
Name: �b -} 4 �Uc- R1(l rP L Tille��'XY� 1 r .-v'l nt -' CW
Phone Number.Q 199U- 57u. -' _Extension: Fax 9C Js Cl
E-mail Address: M(l,`(b",+hpVC(C'\
E. Payment Information -Chock I Money Order Number. 12919 Name on Check / Money Order: Marek Bros Cons t . , Inc
F. Certification
I certify under penalty of law that this document was prepared under my direction or supervision in accordance with a system designed to assure that qualified
personnel property gather and evaluate the information submitted. Based an 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.
Construction Site Operator Representative:
Prefix: Mr. First: Joe Middle: D.
Last: Mare Suffix: Title: Sec/Treas
Signature: Date: 5 / 21 / 03
If you have qu ns on how to fill out this form or about the storm water program, please contact us at (512) 239-4671.
Individuals are antitledto request and reviewtheir personal information thatthe agency gathers on Us forms. They mayatso have anyerrom in their information
corrected. To review such information, contact us at (512) 230-3282.
The completed NOI must be mailed to the following address. Use the attached document to submit the $100
application fee. Please note that the NOI and application fee are submitted separately to different addresses.
Texas Commission on Environmental Quality
Storm Water & General Permits Team; MC - 228
P.O. Box 13087
Austin, Texas 78711-3087
TCEQ-20022 (02/03) Page 1 of 2