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Park West CC(07.2)-PT111115
TCEQ Office Use Only Permit No.: RN: CN: Region ■ 7 TCECd Notice of Intent (NOI) for Discharges from Concrete Batch Plants under TPDES General Permit TXGii0000 IMPORTANT: • Use the INSTRUCTIONS to fill out each question in this form. • Use the CHECKLIST to make certain all you filled out all required information. Incomplete applications WILL delay approval or result in automatic denial. • Once processed your permit can be viewed at http://www.r;.teeg-texas.yov/wg dpa/ APPLICATION FEE: • You must pay the $100 Application Fee to TCEQ for the paper application to be complete. • Payment and NOI must be mailed to separate addresses. See instructions for details. • Did you know you can pay online? • Go to http: / /wwA,.teeg.texas.gov /epav • Select Fee Type: GENERAL PERMIT WASTEWATER DISCHARGE APPLICATION Provide your payment information below, for verification of payment: Mailed M Check /Money Order No.: I ri4q53 Name Printed on Check: SSL EPAY ❑ Voucher No.: Is the Payment Voucher copy attached? ©Yes RENEWAL: Is this NOI a Renewal of an existing General Permit Authorization? 0 Yes The Permit number is: TXG11 OW) ) (If a permit number is not provided, a new number will be assigned.) No a) If the applicant is currently a customer with TCEQ, what is the Customer Number (CN) issued to this entity? You may search for your CN at: http:// wwwl2. tceq. texa. s. gov/ crpub /index.cfm ?fuseaction =cust CustSearch CN 602421679 b) What is the Legal Name of the entity (applicant) applying for this permit? SOUTHERN STAR CONCRETE, INC. (The legal name must be spelled exactly as filed with the Texas Secretary of State, County, or in the legal document forming the entity.) c) What is the name and title of the person signing the application? The person must be an executive official meeting signatory requirements in TAC 305.44(a)• Prefix (Mr. Ms. Miss): MR. First /Last Name: TOMMY ABBOTT Suffix: Title: MANAGING DIRECTOR Credential: TCEQ 10319 (11/07/2011) Page 1 z aged (iTOz/Lo/TT) 61EOT bgD,L :jeiluapaa� :alli.L :xi33nS :am'N Isu�j /Isaid :(sslw 'sw -.IN) xgaad '(p)bp•50£ DVZ in sluauiaimbai zQoleu2is 2uilaatu jpiogJO angnoaxa up aq Isnui uosiad aq L 6uoileailddu all 2uiu2is uosaad aqj jo allil pup aLUpu agI si IpgM (a (•Xlilua aql 2uiutigj Iuautnoop 10aj aql in .io `,fjunoD `alulS jo faelaaoaS sexa,L aqI gl!m pajg se Xlloexa pajjads aq Isntu aLueu juVaj aql) 61iuiaad sigl ioj 2aalddp (lueailddp) Xlilua aqI jo aLUpN 10a-j aql si IugM (q No gaaeaslsno •Isno_uoilopasnj�uzja•xaput qn ao no spxal aoI zTnn : llq :Ip ND anoA ioj gaaeas Xeui nok &,4!jua sigl of panssi (ND) aaquinN aautolsnD aqI si IugM `bT[Dj qlim iaLuolsna u Xjluaaana st Iupoijddp aql jl (H mojaq uoilaas alajduioa `oN❑ '(E uoilaaS oI o� `sa�0 4aolpiadp aqI se atups aql iaunmp aqI sj mlqllXjllr%�. j, �tj 0 9 T :(umoul ji) aaquinN SNfl(I : iagLunN (2uiltj) aalaegD alulS jo upjaaaaS sexay : Q j xp,L je iapaA o9T IT9 :aaqutnN Qj xp,j, asigoupa,d alelS (saolaiadoad ajoS io `IuauivaanoS, `sjenpinipul aoj paainbaa ION •sdigs iaulaud paliLurl pup suoilp iodaoD io3 Qg2Ilfj6aN) :saagtunN 2ulpa pup xu,L ssauisng aauiolsno (q aaq�iigao Tog � aO:0o5 -T9Z© :oSZ -TOT® :OOT -TZ❑ :OZ -o❑ :saa,CojdLug 3o aaqutnN (9 ONO sa ,& ❑ ('«oN„ 43aga `uoilpaodaoo aa�?mj p 3o laud io `Xim is `�flilua leluauzuaan02 jj) 4aolp iadp luapuadapuj (j luauivaanoI) A4iD 0 luauivaanOf) ,Cjunoo Ej IuaLUUaanof) juaapad 0 alplsg 0 uoileaodao j no digs iaulapd juaaua f) [j yg(j- digsaolaiadoad aIOS 0 digsaaulapd paliLuiZ :(acL,fl aauaolsno anoS auiwaalap dlaq jl!m suoilonalsui aq,L) IuaLUUaano,E) aagloM luauivaanof) alplSM Isna,Lp aanluaA ROPE] junPiniPUl❑ aauiolsno ;o adA4 aql alnipuj (a :apOD jvIsod :apoo XijunoD :Saoliaaa.L :vsfl ap!slno 3I 90 :apoD dIZ X,L :aIpIS JNIANI :AT!D :('alg `apOD prW) $uilno-d 1puaaluj Ooa g LIflS AVM)I'HVd .L2I0dgHXd 00 S :ssaappd 2uijipw :li�uz -g o -TZ9 z : oN xp3 :Ixg o -tz9 z :'ON auogd s auioalann tz Luoo•s sn iz IIq :lp ssaappe aql /41aan Sletu noA c(SdSfl) aatnaaS IuiSOd Sfl aql �q paziufooaa sp ssaappe 2uiliuut pup uoilpiu tojui laeluoa (Xliaoglnd ajgisuodsa -j) s,jmjuoD aojeiadb aqI si IegM (p d) What is the Owner Contact's (Responsible Authority) contact information and mailing address as recognized by the US Postal Service (USPS)? You may verify the address at: http: / /Zi 4.usps.com_/ziD44 /welcome jsD Phone No.: Ext: Fax No.: E -mail: Mailing Address: Internal Routing (Mail Code, Etc.): City: State: ZIP Code: If outside USA: Territory:_ Country Code: Postal Code: e) Indicate the type of Cu ❑ Individual [3 Joint Venture ❑ Trust ❑ State Government ❑ Other Government 3tomer (The instructions will h( ❑ Limited Partnership ❑ General Partnership ❑ Estate ❑ County Government alp determine your customer type): ❑ Sole Proprietorship -DBA ❑ Corporation ❑ Federal Government ❑ City Government f) Independent Owner? (If governmental entity, subsidiary, or part of a larger corporation, check "No ".) ❑Yes ❑No g) Number of Employees: 0 -20; ❑ 21 -100; ❑101 -250; ❑ 251 -500; or ❑ 501 or higher h) Customer Business Tax and Filing Numbers: (REQUIRED for Corporations and Limited Partnerships Government, or Sole Proprietors) State Franchise Tax ID Number: Federal Tax ID: Texas Secretary of State Charter (filing) Number: DUNS Number (if known): Not required for Individuals, The Permittee is responsible for paying the annual fee. The annual fee will be assessed to permits active on September 1 of each year. TCEQ will send a bill to the address provided in this section. The Pemittee is responsible for terminating the permit when it is no longer needed. If there is more than one Permittee, which Permittee will be responsible for paying the annual fee? Permittee: SOUTHERN STAR CONCRETE INC. Is the billing contact and contact information the same as the Permittee identified on the line above? MYes, go to Section 4). ❑No, complete section below Prefix (Mr. Ms. Miss): First /Last Name: Title: Organization Name:_ Phone No.: E -mail: Credential: Ext: Fax No.: Suffix: TCEQ 10319 (11/07/2011) page 3 t7 aged (uoz/Lo/Ii) 61£OT 63DZ S b-T Q (i < .It satlunoa ao) XIunoD (p HIaHON00 QHxIN A(IVHX 3O 0NRIf1JDVAfINVW :(apoa SorVN puu DIS aql luadaa lou oQ) :iCltlud paluin2a -d aq} 3o ssautsnq ,Ciuuitad agl agtaasap X13ataq 'spaom umo .inoX uI (a :(paluaoi aaagm Xltunuiutoa aql 4 aql) a}ts io 13afoid3o auuuN (q (mil) aagwnN a3uaaaja2j HN panssi ojD L (u •uotleivaojut alts aAaui aql ut04J zraun,Cuut uotluzuoglnu sup aoi uotluuuaojut alts aq j -moiaq uotluotiddu stgl g2noagl paztaoglnu aq of alts aql aoj U* opew.10jul aql aptnoad puu iagwnN aauaniax XltluH palein2a -d pau2issu agI aptno id `punoj si alts agl3l •gaauaSl Iua as= uotlauasnuu�a xaput qn as �o suxal aaI : llq :lu alts paluin2ai u se panw2ai aq Xpuaaiu XLw alts agl3t aas of,Ca4si23d IealuaD S,O 'AD L gaauaS •alts ia2aei aql aoj pau2tssu M2i agI asfl •alts aa2 ei agl ao3 pau2tssu aq Xpuaaiu XuLu (Nu) aaquunN z�iIlug paluin2a -1 u `sino, aaojaq alts stgl Iu paluaot aaam sassauisnq aaglo 3t ao alts ssautsnq ia2aui u jo laud st ssautsnq inoX 3o alts aql 3I : xtgnS Woo iulsod :apoo fulunoO Woo dIz :alulS ON xu3 :Ixg iutluapaaO :,Caoltaaa j, :ySn aptslnojt uotimiojul 2utppq :,flip it W) 2uilno -d ieuaalul :ssa ippv 2utit w :F,W -H :-ON auogd :aWuN uotlurtuuWa0 : aIIt.L :auiuN Isu"l /Isa13 :(sslw *SW ..IW) xgaad ,Aoiaq uotlaas alaiduioa `ON -DNI `HJ,UDN0D 2IV.LS NNHHJnOS (S uotlaaS 01 011 puu moiaq auti aqI uo aalltutaad gatgm �jpads 'saAn. 43noqu (z uotlaaS io (i uotlaaS ut pagtluapt aalltivaad -OD agl ao aalltivaad aqI su autos aql uoiluuzaojut lauluoa puu laulum uoiluogdde aql sl aq pinoils ogm'uotleatidde stgl2uipie2aa uoipLujojut ieuotltppu spaau OgDL3l :apoo JUIsod :apoo falunoO :,faoltaaaj :vSll aptslno 3t uoileuzaojul 2utit W WOO dIz :alulS :A4t0 :(alb `aPo� It w) 2uilno-d iuuaalul :ssaappd �Ulp w e) Latitude: 1 V ` 9" 59, W Longitude: W 9V' 00' rj' g it f) Does the site have a physical address? El Yes, complete Section A. for a physical address. ® No, complete Section B for site location information. Section A: Enter the physical address for the site. Verify the address with USPS. If the address is not recognized as a delivery address, provide the address as identified for overnight mail delivery, 911 emergency or other online map tools to confirm an address. Physical Address of Project or Site: n 1 Street Number: I,a b ( Street Name: City: Ce D P P L Llr State: TX ZIP Code: Section B: Enter the site location information. If no physical address (Street Number & Street Name), provide a written location access description to the site. (Ex.: located 2 miles west from intersection of Hwy 290 & IH�; accessible on Hwy 290 South) City where the site is located or, if not in a city, what is the nearest city: State: Texas ZIP Code where the site is located: a) Is the project /site located on Indian Country Lands? ®Yes - If the answer is Yes, you must obtain authorization through EPA, Region VI. Coverage cannot be obtained from TCEQ. [DNo — Continue with the next question. b) What is the Standard Industrial Classification Code (SIC Code)? 0 3271 Concrete Block and Brick © 3272 Concrete Products, Except Block and Brick 03273 Ready -Mixed Concrete c) Is this NOI being submitted to include coverage for storm water discharge? © Yes - Complete the Storm Water Pollution Prevention Plan certification below by checking *No Yes. I certify that a Storm Water Pollution Prevention Plan has been prepared and implemented as required in the general permit. [3 Yes d) Discharge Information: Note: If you are only discharging storm water, you may opt to apply for coverage under the Multi Sector General Permit (TXR050000). i. How many outfalls will be used to discharge wastewater and /or storm water at this facility? TCEQ 10319 (11/07/2011) page 5 9 a$ud (iiOZ/LO/ii) 61£OT Og31 .iagtunu Iltuaad anoX Ia2 noX uaigm lun000u 2uilaoda i atuoalaala uu gsilqulsg ao aiuplausuxal ,ti �li�� llg :ip Mou do u2iS ouijuo niep -dw(i Icuigns uL,a noA moux noS pW :apoD lulsod :apoD SilunoD :iumpaaZ :ysfl aptslno3I 90 WOO dIz XI :aluls ONIANI :"413) :(•alj `apoD I!Lw) 2uilno -d luuaalul ooz g.LS Avmxdvd vl0dHH -dA oo s :ssaappv duiliuN :llutuu -g o -iz9 z : oN xu3 :lxg 0-iz9 z :•ON auogd :lutluapaa� NO.IJaHIQ ONIOVNVN :alli.L :xlMns .I.LOgay AbNW01 :auuubl Isu'I /Isatd -dW :(ss'N •sW •aW) xggad suuao3 laoda -d Vu aoltuow a2.ugosiQ I!wgns puu anaoaa of palu2alap ssa ippe 2utuuu alalduoa aagl puu uos iad agl jo auuutu agI apinoad (I -oz££ Vdg) slaoda -d 2uiaolluow a2augasiQ aoj algisuodsa -1 IouluoD (j •uuld uoiluanaad uotlnllod aaluM uuaolS aill jo pud sp papnlaui aq pinogs uvld luawalugy uotlnllod aaluM ao uuld auoz 2uiingtaluo3 pano iddu Xoua2u agI jo Xdoo v paambaa si (£iz aaldugD Dys o£) uuua20id uoilaaload aa3mbV spaunnpg agI aapun aolaaaiQ anilnaaxg agI Xq panoiddu uoilurtioglnu ogiaads alts u lugs alou asuald `saA si aamsuu agl3I ON 0 saA❑ �aajinbV spaumpg agI jo auoz Aaugoag agI 3o uuua.ilsdn saltui (or oI o) ual of oaaz ao `auoz uoiltsuua,L gill uiglinn auoz 2uiingtaluoD agI utgl!m `auoz 5uiingi.iluoD auoz a2augaa,I aql uiq * a2.iugosip Iuilualod ao Aaugosip agI sI :aln -d .iajinbV sp.iumpg (a aaluM gsa-1 aaluM auiauW :auo laalas ( Iluiaad luaaua2 aql ui pagpods sluauua.iinbaa 2uuoltuoiu alquatlddu aulivaalap hl n'%en _]n TTTAA r . .t uu., a—.14- Avfut �LLtL a @IBM qsdAA au ad }eM autauw Olui aaaugasip agl sI -DWOW -� 0 l S 111-Y 4 W aL J. qL VLQ V S N(V Aar /1 Q1 Na Q :ivauu93s oalllssut-2 n Isaauau agI oI llu31no goua tuoaj alnoa a2.iugosip agl jo uoildi.iosap alalduuoa u apinoid 'Al '" cgma.i ,�Ilunluana [Jim a2a9g3sip aql lugl (s)Apoq ialum pagpsup agl jo (s)aaquunu Iuatu2as alp Si lugM ttt �J J N (It I �a2augostp agI anlaaaa oI poq ialLm is ig agl jo aweu agl sl IugM tt 'aaluM uiaols glint pauiquIoa aaluMalsuM put? aalLmalsu.ti 2ui2augasip sllujlno ioj paatnbaa si (ZII,�Q) :podag 2utaolluoW a2augasiQ V :,910N 4aalumalsune glim pauiquioa aalum ivaols aau sllujlno kaput mOH Zaalumalsum aau s1lu3lno Iuuuu mOH 4aalum uuaols a iu sllu3lno ,fuuuu mOH :sIlu31n0 Iulo L Check Yes to the certifications below. Failure to indicate Yes to ALL items may result in denial of coverage under the general permit. a) I certify that I have obtained a copy and understand the terms and conditions of the general permit TXG110000. E]Yes b) I certify that the activities at this site qualify for coverage under the general permit TXGii0000. E]Yes c) I understand that a Notice of Termination (NOT) must be submitted when this authorization is no longer needed. E]Yes d) I understand that permits active on September ist of each year will be assessed an Annual Water Quality Fee. E]Yes e) I certify that the full legal naive of the entity applying for this permit has been provided and is legally authorized to do business in Texas. E]Yes TCEQ 10319 (11/07/2011) Page 7 b-zi g a2rd (TToz/Lo/Ti) 61EoT OHDL (�lui anlq asn) :aleQ :aanluuft •Isanbaa uodn uoiluzuoglne cans jo 3oo id ui uoeluauinop apinoad ueo pue `luaunoop siq l Itu gns pue u&s of b•So£ § apo,) anlualstuiUy Z ue I egl Sjtl iao .iagl inj I p suoilulotn 2utmoux aoj luauiuosuduut pue aug jo Sltligissod aqj ftpnlaut `uotleuiao3ui asluj 2uTI1iuigns aoj sailleuad lueotgtu2ts am, aiagl aaumb, uie I •alalduioo pue `aluanooe `anal `jailaq pue a2palmouA Sw jo Isaq aqj of `si palltutgns uoileuuaojui aqj `uotleuiaojui aql 2ui iagle2 ao3 algisuodsa i Xlloa itp suosaad asogl io `wajs,Cs aql a2muui oqm suosaad .to uosaad aql jo ,Cainbui Xw uo paseg •palliTUgns uoilew iojui aql alenlena pue iagle2 xlaadoad lauuos.iad pagiienb legl aanssu of pau2isap uialsSs u gIlm aouepa000e ui uotstnaadns io uotloanp Xtu .iapun paaudaad aaam sluauigoulle 1pe pue luautnoop sigl Iegl l"el 3o x4puad aapun �iliao alU auinu palu} id io padfiL `I •slueoilddu -oo sapnpui aole iado aql uagm sa inleu2is leuotlippe aoj luauugaelle a2ud aanluu2is aql asrl •lueoildde -oo goea io3 paainbaa si aanluu2is V :UOIIC3gtP3a aaunAO i f i I j •aleQ (�ui anlq asn) a inluu2iS •Isanbaa uodn uotluniapne guns jo3ooad ui uotluluatumop apinoid um pue `luauinoop stql Itutgns puu u21s of tab So£ § apoD antlealsiuiuipy suxaZ o£ aapun pazi ioglnu mu I Iugl Xilaaa aagl inj I suotlelotn gutmou)l ioj luauiuosi idun pue auij 3o ,�Iiligissod aql guipnlaut `uotluuiaojut asle3 2uillicugns ao3 sappuad luuot3tu2is axe aiagl aiPme Tuu I •alaldiuoo puu `aluanoau `anal `3ailaq pun a2palmouA Xw jo Isaq aql oI `st palltuigns uoiluw iojui aql `uoileuiaojui agl 2uiaagle2 ao3 algisuodsaa flloaatp suosaad asoql ao `IUalsAs aqj a2uueui oqm suosiad ao uosiad agl jo Xiinbui Ai uo paseg •palliutgns uotleuiaojui agl alenlena pue iagle2 Xpadoad lauuosaad pagtlunb Iugl aanssu of pau2isap tualsXs e glint aouepa000u ui uoistnaadns io uotloaatp Xw aapun paaudaad a iam sluauigoellu Ite puu luauinoop sigl Iegl Mel jo Xipeuad aapun �ilaaa allt.L atuvu paluud io padFil NOIDUIQ ONIDVNVw .LL099V AWWO L `I •slueotldde -oo sapnlaui aoleaado aql uagm saanleu2is Iuuoilippu ao3 luauigae:nu a2ud aanluu2is aqj asn •Iue;)gddu -oo goua aoj paunbai st ainluu2is :uo eagiwaZ) aojujadp o � z V M •� L c F+ O o�oOL 3 tz F� cs cn tZ O��W[ O' Q� cq W W W w C4 h � +� o zOv)x O U cn 00 G) N y 7d a L Ln cn CI- O ~ c c F-1 Nom. 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