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HomeMy WebLinkAboutNOI APR 30 2003 2: 02PM PEBBLE CREEK 979-690-6081 p. 2 APR-29-2003 TUE 04:40 PM YOUNG CONTRACTORS FAX NO 9798232797 P. 02 F (Aa- c...!*.(2 . z Notice of Intent(N01)for Storm Water Discharges TCE0 Office use Only Associated with Construction Activity under the TPDES Permit Number:TXR15'. •_'_'_•`NO TPDESConstruction General Permit(TXR150000) GIN Number•• •• •• •• •• •• •- •• For help competing tHs application,read the TXR150000 NO1 Instructions (TCEO-20022•Inseuetiono). A. Construction Site Operator :.1 New M No Change Customer Reference Number.CN Name:Youna;ontpgtors,Jpp. Ci Bien State:, Zlp Code;7780* Mailing Address:P.O.Box*74 �: � Postal Code: Country Meiling Information(N outside USA)Territory. • Country Code: Phone Number._ 979-779-1112 Extension: Fax Number: 979-82352797 Email Address:kehhnlersonSvounocontrsstars.com Type of Operator.Cl Individual 0 Sole Proprietorship-D.B.A.0 Partnership®Corporation 0 Federal Government p State Government CI County Government Cl City Government Q she.: Independent Operator? ®Yes In No Number of Employees: ©0.20©21.100©101-250 ®251-500 ©501 or higher Federal Tax ID: 7.24761 State Franchise Tax ID Number. 17426567510 DUNS Number. 01$528542 8. Billing Address Name:Yoiaue Contractors,Inc. , Mailing Address:P.O.I90x 574 City:Reran Siate: Zip Code:7790* Country Mailing Information(troutside USA)Territory: Country Code: Postel Code: . C. Project 1 Site information New I No Change Regulated Entity Reference Number.RN --- Name::Pebble Creek Addition Phase se State:_Zip Code:, Mailing Address:Same�s sec4lon A �' Physical Address:Southard!of Royal Atelatde Drive City:Calico.Station County;MIATos . Zip Code:77845 Location Access Description:Nortwct of Fitpval Air.and Salesmen Hills Dr interaectlon Latitude: 30 'ij'45 " N Longitude:96 •i3 'IL° W Degrees(•),Minutes('),and Seconds(") Latitude: Longitude:— Decimal Form Standard Industrial Classification(SIC)code: 18 Also,describe the construction activity at this site(do not repeal die SIC code): Construct New Streets And Utilities For,Housina:Subdivision ... • . . . Hes a storm water pollution prevention plan been prepared as spedflsd In the general permit(TXR150000)? ®Yes Cl No Estimated area of land disturbed(to the nearest acre):5 le the project/site located on Indian Country Lands? [{Yes®No Does this project I site discharge storm water into a municipal separate storm sewer system(MS4)?©Yes IP No If yes,provide the name of the SASS operator: Provide the name or segment number of the water body that receives storm water from this project/site:Alum Creek D. Contact-If the TCEO needs eddilionet information regarding this applcation.who should be contacted? Name: Keith J.Pherson Tia:Assistant Corp Secretary Phone Number: 979-779.11/2 Extension: Fax Number: 979.823.2797 E-mail Address:keithplersoneYoufDcontractarsfom E. Payment Information•Check I Money Order Number: 83051 Name on Check I Money Order.Young Cor. .,....r 1 F. Certification I certify under p.mlty of law that this documem was prepared under my direction or auperviaion in accordance with a system designed to assure that qualified personnel property pother end evaluate the information submitted.Based on my Inquiry of the person or persons who miner the system,or thew persons directly responsitte for gathering the Information,the information eubmtled Is;to the beat of my knowledge:and belief,true,accurate,and convert*. I am aware there are significant peneaies for,submitling fake Information.including the possibMy of fine and Imprisonment for knowing violations. • Conetniotion Site Operator Representative: Prefix:Mr. First:Keith Middle:Jackson Last Pierson . ,, Suffix: Title:Assistant Corp Secretory . Signature: K.at rL /A -' v Date: 1//.23/45.3. It you have questions On how l0 as out this form or about the storm Pater progr■m,please contact us et(512)239-4671, Ineividualeare entitled torequest end review their personal tnf rmalonthattheagencygathersonItsforms.They may also naw any errors mtheir inform.tion eerreeted.To review such Information.contact uc at(512)230-3252, Ire completed NOI must be mailed to the following address. Use the attached document to submit the$100 application fee. Please note That the NON and application fee are submitted separately to different addresses. Texas Commission on Environmental Quality Storm Water&General Permits Team;MC•228 P.Q.Box 13087 Austin.Texas 78711.3057 Page 101 2 TCEQ40022(02103) RPR 30 2003 2: 02PM PEBBLE CREEK 979-690-6081 P. 3 APR-29-2003 TUE 04:40 PM YOUNG CONTRACTORS FAX NO. 9798232797 P. 03 Texas Commission on Environmental Quality payment Submittal Form The storm water application fee shall be sent under separate cover to the Taxes Commission on Environmental Quality. This form must be used to submit your Storm Water Application Fee. Please complete the following information,staple your check in the space provided a1 the bottom of this document,and mall it to: y REGU sR U.S.MAIL BY dyERNNGHTIEXPRaSS MAIL_ Texas Commission on Environmental Quality Texas Commission on Environmental Duality Financial Administration Division Financial Administration Division Cashier's Office,MC-214 Cashier's Office,MC-214 P.O. Box 13088 12100 Park 35 Circle Austin.TX 78711.3088 Austin,TX 78753 • Fee Code:(SPA, Storm Water General Permit: TXR150000 Check/Money Order No: 63051 Amount of Check/Money Order 100.00 Date of Check or Money Order. M23104 Name on Check or Money Order. Young Caetraomrs,Ina Facility I Site Name:Pebble Greek Addition Phase sig Facility I Site Physical Address: Southeast of Royal AdNkide Drive City:Collie.Station Zip Code:77046 Staple Check in This Space rash9of3 TCEQ-20022(02/03)