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F "Jq= 0 Notice of Intent (NOI) for Storm Water Permit N o.: TXR 1 5
La '1!N_ Discharges Associated with Construction RN:
MR.
Activity under TPDES General Permit CN:
TCEQ (TXR1 50000) Ref No:
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If filing a paper NOI you can pay the application fee on line? Go to lit t ps-i"Ai vvvt 6.tceq.s[a tc.tx. uslepay/
IMPORTANT:
-Use the INSTRUCTIONS to fill out each question in this form.
-Use the attached CUSTOMER CHECKLIST to make certain all you filled out all required information.
-Incomplete applications WILL delay approval or result in automatic Denial.
Renewal of General Permit
Is this NOI to renew an ACTIVE permit?
Yes - What is your permit number? Permit No. TXR15
No - a permit number will be issued.
Application Fee if mailing a paper NOI:
You must pay the ;; Application Fee to TCEQ for the application to be considered complete.
Payment and NOI must be mailed to separate addresses. See instructions for correct mailing addresses.
Provide your payment information below, for us to verify payment of the application fee:
Mailed:
Check/Money Order No.:
Company Name on checking account:
SPAY:
Voucher No.:
Is the Payment Voucher copy attached? 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 Central He stry
2. What is the Legal Name of the entity (applicant) applying for this permit?
College Station MarketPlace L.P.
(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 name and title of the person signing the application?
(The person must be an official meeting signatory requirements in TAC 305.43(a).)
_T
Name: Mike Coontz
Job Title: Owner's Rep
4. What is the Operator's (applicant) mailing address as recognized by the US Postal Service? f � er-f' a CSPS.com,
Address: 520 Post Oak Blvd.
I Suite No./Bldg. No./Mail Code: 850
City: Houston
State:Texas
I
ZIP Code: 77027
I
Country Mailing Information (if outside USA). Country Code: Postal Code:
5. Phone No.: (713 ) 623-0188
Extension:
6. Fax No.:
E-mail Address:
7. Indicate the type of Customer:
❑ Individual ❑Sole Proprietorship-D.B.A. El Limited Partnership
❑Corporation ❑Federal Government ❑General Partnership
❑ State Government ❑County Government ❑City Government
❑Other Government 0 Other (describe):
- 1 - CEQ-20022 (03/05/2008) rage I
8. Independent Operator: 1 1 iYes ❑No (If governmental entity, subsidiary, or part of a larger corporation, check "No".)
9. Number of Employees: ❑0 -20; E]21-100; E1101-250; 0251 -500; or EJ50I or higher
1 Customer Business Tax and Filing Numbers (This item is not applicable to Individuals, Government, GP or Sole Proprietor.)
REQU IRED for Corporations and Limited Partnerships , % eH6 0 -1 ,
State Franchise Tax ID Number:
Federal Tax ID:
TX SOS Charter (filing) Number:
DUNS Number (if known):
B. APPLICATION CONTACT
If TCEQ needs additional information regarding this application, who should be contacted?
L Name: Craig Artze
Title: Engineer
Company: Brewer & Escalante
2. Phone No.: ( 832 ) 615-0331
Extension:
3. Fax No.: 713 688-5476
E-mail Address: cartze@brewer-escalante.com
C. REGULATED ENTITY (RE) INFORMATION ON PROJECT OR SITE
1. TCEQ Issued RE Reference Number (RN): RN
2. Name of Project or Site (the name as known by the community where this facility/project is located):
College Station Marketplace - Chase Bank
(example: phase and name of subdivision or name of project that's unique to the site)
3. Does the site have a physical address?
If Yes, complete Section A for a physical address.
If No, complete Section B for site location information.
Section A: Enter the physical address for the site.
Street Number:
Street Name:
City:
ZIP Code:
Section R: Enter the site location information.
If no physical address (Street Number & Street Name), provide a written location access description to the site:
(Ex.: phase I of Woodland subdivision located 2 miles west from intersection of Hwy 290 & IH35 accessible on Hwy 290 South)
Appoximately 1/2mile Southwest of Hwy 6, Along Hwy 40
City where the site is located or nearest city to site:
College Station
ZIP Code where site is located:
1 77845
4. Identify the county where the site is located: Brazos
5. Latitude: N 30d 33' 30"
1 Longitude: W 96d 15' 36"
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) National Bank Branch Office
7. What is the mailing address for the regulated entity?
Is the RE mailing address the same as the Operator? OYes, address is the same as Operator F No, provide the address
Street Number: I
Street Name:
City:
State:
ZIP Code:
D. GENERAL CHARACTERISTICS
1. Is the site located on Indian Country Lands? F71 N o ❑Yes — If Yes, do not submit this NOL Contact EPA, Region VI
If the site is on Indian country lands, you must obtain authorization through EPA, Region VI.
2. What is the Standard Industrial Classification (SIC) code (see instructions for common codes): Osha.gov�
Primary: 6021 Secondary: 6091
TCEQ -20022 (03/05/2008) Page 2