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NOC for Yr 5 (NDCFCD) Ir Notice of Change (NOC) to an Authorization TCEQ Office Use Only a — Permit No.: WNW for Storm Water Discharges from Small RN: Municipal Separate Storm Sewer Systems CN: TCEQ (MS4) under the TPDES Phase II MS4 General Permit (TXR040000) * * * ** IMPORTANT * * * ** PLEASE READ THE FOLLOWING INFORMATION AND INSTRUCTIONS BEFORE FILLING OUT THIS FORM. The form will be returned for one of the following reasons: 1) the permit number is not provided, invalid, or no longer active, 2) a wet ink signature of person meeting signatory requirements for permittee is not provided, 3) the current permittee is not the applicant, and; 4) a requested change in operator name is not a legal name change . THIS FORM CANNOT BE USED FOR A CHANGE IN OPERATOR. REFER TO YOUR GENERAL PERMIT. What is the Permit Number of the authorization to be changed? TXR04 0053 A. APPLICANT INFORMATION: Search Central Registry at http : / /wwwl2.tceq.texas.gov /crpub/ 1. Operator (Permittee) a. What is the full Legal Name of the current Operator as on the authorization? Northwest Dallas County Flood Control District b. What is the TCEQ Central Registry Customer Number assigned to this Operator? CN 600650584 2. Permitted Site (required) What is the TCEQ Central Registry Regulated Entity Number assigned for this permitted site? RN 105483846 B. REQUESTED CHANGE TO PERMITTED INFORMATION What information has changed or needs corrected? (Check one or more of the sections being updated and enter the new information in the corresponding section of this form.) Ej Operator Legal Name Change with Texas Secretary of State (TX SOS). (Note: Permits are not transferable. If a change in entity has occurred, this NOC is not attainable.) 0 Address and contact information for Operator, Billing for Annual Fee or Site Mailing Address. © Site Information (Regulated Entity) (Note: Permits under a general permit are site specific. If a change in site location has occurred, this NOC is not attainable.) 12 Change To The Approved SWMP 1. OPERATOR LEGAL NAME CHANGE a. What is the NEW active Legal Name with TX SOS or on other legal document? New Legal Name: b. What is the TX SOS Filing Number for us to confirm this official name change? (This is only applicable to Limited Partnership or Corporations.) 2. ADDRESS & CONTACT INFORMATION CHANGE a. What mailing address and/or contact information has changed? (check one or more as applicable) © Operator for permit correspondence (RE) Mailing Address and contact information Billing address /contact for Receiving Annual Fee Statement b. If you selected more than one, is the information to be updated the same for each selection? 0 Yes – Provide the updated information in the fields below. ® No – Attachment 1 of the NOC is attached to this form, to provide the different addresses. ATTN or C /O: Address: Suite No./Bldg. No./Mail Code: City: State: ZIP Code: Country Mailing Information (if outside USA). Country Code: Postal Code: Phone No.: ( ) Ext: Fax No.: ( ) E - Mail: TCEQ- 20392 (08/14/2007) Page 1 3. REGULATED ENTITY (RE) SITE INFORMATION CORRECTION or UPDATE a. Updated or Corrected description of the regulated MS4 boundaries: b. Other update to regulated entity information. Please explain. 4. CHANGE TO THE APPROVED SWMP Check the applicable item(s) to be changed or updated and complete the section for each item. Reference the attachment for each item. El Add the 7 Minimum Control Measure (MCM) to the approved SWMP. Complete Attachment 2 of the NOC and the following question: Are you seeking to use the 7` MCM only in the regulated (urbanized) area? ® Yes - Attach the MCM with Attachment 2 of the NOC. No — Attach the MCM with Attachent 2 of the NOC and indicate YES to the following certification: I certify that the MS4 is in compliance with all of the MCMs listed in this general permit, in the MS4's additional area where the 7 MCM will be utilized. OYES Failure to indicate YES to this certification will result in denial. 12 f Notice to update the approved SWMP adding components, controls, or requirements to the SWMP; or replacing a BMP with an equivalent BMP. Are the revisions to the approved SWMP attached? E+ Yes, under attachment 1 ID Request to update the approved SWMP, replacing a less effective or infeasible BMP specifically identified in the SWMP with an alternate BMP. Are the revisions to the approved SWMP attached? QYes, under attachment 0 Other requested changes to the approved SWMP requiring TCEQ approval. Are the revisions to the approved SWMP attached? • Yes, under attachment C. APPLICATION CONTACT If TCEQ needs additional information regarding this application, who should be contacted? 1. Name: Mike Garza Title: Graduate Engineer Company: City of Coppell 2. Phone No.: (972 ) 304 -7019 Ext: Fax No.: ( ) E -Mail: mgarza @coppelltx.gov D. CERT IFICATION Operator Certification: Typed or printed name (REQUIRED) Title (REQUIRED) certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate 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 fine and imprisonment for knowing violations. I further certify that I am authorized under 30 Texas Administrative Code §305.44 to sign and submit this document, and can provide documentation in proof of such authorization upon request. Signature: Date:_ (Use blue ink) (REQUIRED) (REQUIRED) TCEQ- 20392 (08/14/2007) Page 2 • Attachment 1 to a NOC Form for Providing Different Address & Contact Information Related to a Specific Permit under General Permit TXR040000 What is the Permit No.? TXR04 0053 (REQUIRED) ADDITIONAL ADDRESS & CONTACT INFORMATION Fill in the changes as applicable. Incomplete and invalid addresses will not be used. Verify mailing addresses at USPS.com. Operator ATTN or C /O: Address: Suite No./Bldg. No./Mail Code: City: State: ZIP Code: Country Mailing Information (if outside USA). Country Code: Postal Code: Phone No.: ( ) Ext: Fax No.: ( ) E -Mail: Billing Address for Receiving Annual Fee Statement ATTN or C /O: Address: Suite No. /Bldg. No./Mail Code: City: State: ZIP Code: Country Mailing Information (if outside USA). Country Code: Postal Code: Phone No.: ( ) Ext: Fax No.: ( ) E - Mail: Site (RE) Mailing Address ATTN or C /O: Address: Suite No. /Bldg. No. /Mail Code: City /State: ZIP Code: Country Mailing Information (if outside USA). Country Code: Postal Code: Phone No.: ( ) Ext: Fax No.: ( ) E - Mail: TCEQ- 20392 NOC Attachment 1 (08/14/2007) Page 1 Attachment 2 to a NOC Form for adding the Optional 7 Minimum Control Measure 7 Minimum Control Measure Cover Sheet This cover sheet MUST be completed by indicating the page number where the requested item will be found in the MCM. Provide the page number in the left column for each item. The questions relating to the Edwards Aquifer must also be answered. This cover sheet MUST be attached to the front of the MCM. Operator Name on NOI: Northwest Dallas County Flood Control District Page # (s) Optional 7th MCM : Municipal Construction Activities (only available within the regulated area where the MS4 operator meets the definition of construction site operator) If this MCM is utilized applicable, SWMP must include the following information: Description of how construction activities will generally be conducted so as to take into consideration local conditions of weather, soils, and other site specific considerations Description of the area that this MCM will address and where the MS4 operator's construction activities are covered (e.g. within the boundary of the urbanized area, the corporate boundary, a special district boundary, an extra territorial jurisdiction, or other similar jurisdictional boundary) If the area included in this MCM includes areas outside of the UA, then all MCMs will be implemented over those additional areas as well. Description provided for one of the following: ► How contractor activities will be supervised or overseen to ensure that the SWP3 requirements are properly implemented at the construction site(s); or ► How the MS4 operator will make certain that contractors have a separate authorization for storm water discharges if needed. General description of how a construction SWP3 will be developed for each construction site. Edwards Aquifer Rule Is the discharge or potential discharge from regulated construction activities within the Rechaate Zone, Contributing Zone, or Contributing zone within the Transition zone of the Edwards Aquifer? QYes WI No If the answer is "Yes ", please note that a copy of the agency approved Plan required by the Edwards Aquifer Rule (30 TAC Chapter 213) must be either included or referenced in the construction storm water pollution prevention plan(s). TCEQ- 20392 NOC Attachment 2 (08/14/2007) Page 1 SUMMARY FOR PERMIT IMPLEMENTATION / ANNUAL REPORT TRACKING / YEAR 4 Program Activity Department / Person Post 2 storm water quality messages in the City Desk. Community Information Officer i I Update website with storm water quality information. f City Engineer Public Education and Outreach Continue labeling of the residential storm drains. Document the number of storm drains labeled. City Engineer Continue current public education programs and affiliations. Document the number of Community Information Officer events and the number of people attending Continue to Provide State and local Required Public Notices for meetings, hearings and City Engineer/Community Information Officer puhlications regarding storm water management. 2. - - Public Post the updated to the SWMP (if plan is updated) for public review and comment at the Involvement/ j City Engineer Community Information Officer Office of the City Secretary. A copy will be posted on the city web site. Participation Post SWMP Annual Report for public review and comment. City' Engineer /Community Information Officer 3, Perform annual field staff training to detect and eliminate illicit discharges City Engineer Illicit Discharge Detection and Elimination Update GIS map with storm water quality data and new facilities. City Engineer Implement Illicit discharge ordinance - Moved to year 5 City Attorney /City Engineer 4. , Document any citizen complaints and corrective action taken. Community Information Officer/City Engineer City of Coppell 7 Summary for Implementation Storm Water Management Plan