ST0502B- PT140908To: Brian Colin
CT
LLC
M
exas 76162
[65
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S WP3 documents transmittal
From: Todd Webster
Re: Prologis Park One Twenty One
Email brian@earthbasics.net
Date: 9/8/2014
Pages:
The following is the required paperwork for the above mentioned project. It contains a Primary Operator NOI for
the Contractor and a Secondary Operator CSN for the Owner to execute. The NOI for•ln needs additional
information -see areas with BOLD outlined box. Please review the following chart for destinations for each of the
forms once they have been signed in BLUE INK by an OFFICER of the Company.
FORM
DESTINATIONS after signatures - our fax #: 866.228.1586
Contractor's NO] & Recei t
Mail to TCE 's and to MS4's address shown below,• fax/email back to us.
Owner's CSN
Fax/email back to us.
SWP3 Certification:
Fax/email back to its.
Delegation Letter:
Fax/email back to us.
Please send the NOIs to the addresses listed below via certified mail: (Original to TCEQ, copy to MS4)
MS4 Address: TCEQ Address:
City of Coppell TCEQ
Engineering Department Storm Water Processing Center (MC -228)
255 Parkway Blvd P.O. Box 13087
Coppell, TX 75019 Austin, Texas 78711-3087
Attn: NOI Processor
Our SWP3 binders will not be delivered without signed paperwork. Please return the following paperwork as soon
as possible to avoid beginning the project out of compliance with the TCEQ.
If you have any questions, please call me. Thank you again for your business.
Sincerely,
Todd Webster
Project Compliance, LLC
IC'Llflinu -�-—IM"/roDD'a 61ac8u:k Au Copy6ghl 0 2014 P.i3O C—Pl1:w,.LLC. All Riehl, R.—,d 866.22R 1586
TCEQ Office Use Only
Permit No.:
RN:
CN:
Region:
M"
TCEQ Notice of Intent (NOI) for Stormwater Discharges
Associated with Construction Activity under TPDES
General Permit (TXR150000)
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: //1%IXVX-k'2.tceq.texas.gov/wcI dpa/index.cfm
ePERMITS: Sign up now for online NOI: https: //4�tiv�� _�.tcec� texas.gov/steers/index.cfiii
Pay a $225 reduced application fee by using ePermits.
APPLICATION FEE:
• You must pay the $325 Application Fee to TCEQ for the paper application to be
complete.
• Payment and NOI must be mailed to separate addresses.
• Did you know you can pay on line?
• Go to https://xvwx ��.tceq.texas.gov/epay/index.cfm
• Select Fee Type: GENERAL PERMIT CONSTRUCTION STORM WATER
DISCHARGE NOI APPLICATION
• Provide your payment information below, for verification of payment:
Mailed Checic/Money Order No.:
Name Printed on Check
EPAY Voucher No.: 2.18256
Is the Payment Voucher copy attached? Yes
RENEWAL: Is this NOI a Renewal of an existing General Permit Authorization?
(Note: A permit cannot be renewed after June 3, 2013.)
Yes The Permit number is: TXR15
(If a permit number is not provided, a new number will be assigned.)
X' No
ATOR (Applicant) I
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:
hLLp://w x%,%vl2.Lceq.texas.gov/crpub/index.efiii?fuseaction=cust.CustSearch
CN
TCEQ 20022 (03/05/2013) Page 1
b) What is the Legal Name of the entity (applicant) applying for this permit?
C
Earth Basics Contracti" Carp.
(The legal name must be spelled exactly as filed with the Texas Secretary of State, County, or
in the legal document forming the entity.)
wnat is the name ana title or the person signing the appiication_e -rt
executive official meeting siory requirements in TAC 305.44(a)•
Prefix (Mr. Ms. Miss •
First/Last
Title: Credential:
e person must be an
x:
What is the Operator Contact's (Responsible Authority) contact information and mailing
address as recognized by the US Postal Service (USPS)? You may verify the address at:
littp://zip4.usl)s.com/ziA4/welcoine.jsp Name: Brian Colin
Phone #: 817.349.6322 ext: Fax #:
E-mail: briaii@eartlibas2cs.net
Mailing Address: 4012 Gateway Dr Ste 140
Internal Routing (Mail Code, Etc.):
City: Colleyville State: TX ZIP Code: 76034
If outside USA: Territory: Country Code: Postal Code:
e) Indicate the type of Customer (The instructions will help determine your customer type):
❑ Individual ❑ Limited Partnership ® Corporation
❑ Joint ❑ General Partnership ❑ Federal Government
❑ Trust ❑ Estate ❑ City Government
❑ State Government ❑ County Government
❑ Other Government ❑ Sole Proprietorship-D.B.A.
f) Independent Operator? ® Yes ❑ No
(If governmental entity, subsidiary, or part of a larger corporation, check "No".)
g) Number of Employees:
E10-20 ❑21-100 ®101-250 E3251-500 ❑ 501 or higher
h)
Customer Business Tax and Filing Numbers:
(REQUIRED for Corporations and Limited Partnerships.
Government, or Sole Proprietors) /,�
State Franchise Tax ID,*µml��U
Federal Tax ID: 77 GG((pp
Texas Secretary of State Chart xlin ) `Number:
DUNS Number (if known): r (SOD -- Z
Not Required for Individuals,
).\.PPLICATION CONTACT
If TCEQ needs additional information regarding this application, who should be contacted?
Is the application contact the same as the applicant identified above?
❑X Yes, go to Section 3). No; complete section below.
Prefix (Mr. Ms. Miss):
First/Last Name: Suffix:
Title: Credential:
TCEQ 20022 (03/05/2013)
Page 2
Organization Name:
Phone No.: ext: Fax Number:
E-mail:
Mailing Address:
Internal Routing (Mail Code, Etc.):
City: State: ZIP Code:
Mailing Information if outside USA:
Territory: Country Code: Postal Code:
If the site of your business is part of a larger business site or if other businesses were located at
this site before yours, a Regulated Entity Number (RN) may already be assigned for the larger
site. Use the RN assigned for the larger site. Search TCEQ's Central Registry to see if the larger
site may already be registered as a regulated site at:
litlp: //WU'W12.tceq. texas.gov/crptib jindex.cfin?fuseactioii=regent. RNSearch.
If the site is found, provide the assigned Regulated Entity Reference Number and provide the
information for the site to be authorized through this application below. The site information
for this authorization may vary from the larger site information.
a) TCEQ issued RE Reference Number (RN): RN
b) Name of projector site (the name known by the community where located):
Prologis Park One Twenty One
c) In your own words, briefly describe the primary business of the Regulated Entity: (Do not
repeat the SIC and NAICS code):
Channel improvements
d) County (or counties if > i) Dallas
e) Latitude: 32.97976 Longitude: -97.011641
t) Does the site have a physical address?
Yes, complete Section A for a physical address.
:X 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:
Street Number: Street Name:
City: State:
ZIP Code:
TCEQ 20022 (03/05/2013) Page 3
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 & IH35
accessible on Hwy 290 South)
Approx 339 N Coppell Rd West side of Coppell Rd across from W PArkwav Blvd
City where the site is located or, if not in a city, what is the nearest city:
Coppell
State: Texas ZIP Code where the site is located: 75019
Is the project/site located on Indian Country Lands?
Yes - If the answer is Yes, you must obtain authorization through EPA, Region 6.
® No
b) Is your construction activity associated with a facility that, when completed, would be
associated with the exploration, development, or production of oil or gas or geothermal
resources?
Yes - If the answer is Yes, you may be under jurisdiction of the Railroad Commission
of Texas and may need to obtain authorization through EPA, Region 6.
; No
c) What is the Primary Standard Industrial Classification (SIC) Code that best describes the
construction activity being conducted at the site?
Primary SIC Code: 1794
d) If applicable, what is the Secondary SIC Code(s):
e) What is the total number of acres disturbed?
f) Is the project site part of a larger common plan of development or sale?
Yes - If the answer is Yes, the total number of acres disturbed can be less than 5 acres.
)( No - If the answer is No, the total number of acres disturbed must be 5 or more. If
the total number of acres disturbed is less than 5 then the project site does not
qualify for coverage through this Notice of Intent. Coverage will be denied. See
the requirements in the general permit for small construction sites.
g) What is the name of the first water body(s) to receive the stormwater runoff or potential
runoff from the site?
Denton Creek
h) What is the segment number(s) of the classified water body(s) that the discharge will
eventually reach?
0825
TCEQ 20022 (03/05/2013) Page 4
i) Is the discharge into an MS4?
X Yes - If the answer is Yes, provide the name of the MS4 operator below.
No
If Yes, provide the name of the MS4 operator:
City of Coppell
Note: The general permit requires you to send a copy of the NOI to the MS4 operator.
j) Are any of the surface water bodies receiving discharges from the construction site on the
latest EPA -approved CWA 303(d) List of impaired waters?
Yes - If the answer is Yes, provide the name(s) of the impaired water body(s) below.
X! No
If Yes, provide the name(s) of the impaired water body(s):
k) Is the discharge or potential discharge within the Recharge Zone, Contributing Zone, or
Contributing Zone within the Transition Zone of the Edwards Aquifer as defined in 30 TAC
Chapter 213?
!Yes -If the answer is Yes, complete certification below by checking "Yes."
:X No
I certify that a copy of the TCEQ approved Plan required by the Edwards Aquifer Rule
(3o TAC Chapter 213) is either included or referenced in the Stormwater Pollution
Prevention Plan.
Yes
TCEQ 20022 (03/05/2013) Page 5
Check Yes to the certifications below. Failure to indicate Yes to ALL items may
of coverage under the general permit.
a) I certify that I have obtained a copy and understand the terms and conditions of the
Construction General Permit (TXR150000). F� Yes
b) I certify that the full legal name of the entity applying for this permit has beenMes
ded
and is legally authorized to do business in Texas.
c) I understand that a Notice of Termination (NOT) must be submitted when this
authorization is no longer needed. ❑ Yes
d) I certify that a Stormwater Pollution Prevention Plan has been developed, will be
implemented prior to construction and to the best of my knowledge and belief is
compliant with any applicable local sediment and erosion control plans, as required in
the general permit TXR150000. Note: For multiple operators who prepare a shared
SWP3, the confirmation of an operator may be limited to its obligations under the
SWP3 provided all obligations are confirmed by at least one operator. F� Yes
Operator Certification:
/4%v0�,����
Typed or printed name
gx--�-
Title
under penalty of law that this document and all attachments were prepared under my
an or supervision in accordance with a system designed to assure that qualified personnel
ly gather and evaluate the information submitted. Based on my inquiry of the person or
s who manage the system, or those persons directly responsible for gathering the
ation, the information submitted is, to the best of my knowledge and belief, true,
te, and complete. I am aware there are significant penalties for submitting false
ation, including the possibility of fine and imprisonment for knowing violations.
further certify that I am authorized under 3o Texas Administrative Code 305.44 to sign and
Abmit this document, and can provide documentation in proof of such authorization upon
:quest.
ignature: Date:
(Use blue ink)
20022 (03/05/2013)
Page 6
Questions or Comments >>
Print this voucher for your records. If you are sending the TCEQ hardcopy documents related to this payment,
Include a copy of this voucher.
Voucher Number. 218256
Trace Number: 582EA000173908
Date: 09/08/2014 11:06 AM
Payment Method: CC - Authorizatlon 000075932K
Amount: $325.00
Fee Type: General Permlt Water Discharge Applicatlon
ePay Actor. Todd Webster
Actor Email: Codd@projectcompllance.com
IP: 24.182.202.4
-Payment Contact Information
Name: Todd Webster
Company: Project Compliance Llc
Address: P 0 Box 16406, Fort Worth, TX 76162
Phone: 817-975-3165
-gun unvnnauvn
Site Name: PROLOGIS PARK ONE TWENTY ONE
Site Location: APPROX 339 N COPPELL RD WEST SIDE OF COPPELL RD ACROSS FROM W PARKWAY BLVD
-Customer Information
Customer Name: EARTH BASICS CONTRACTING CORP
Customer Address: 4012 GATEWAY DR 140, COLLEYVILLE, TX 76034
.........................................................................................................................................................................................................
Site Help I Disclaimer I Web Policies I Accessibility I Our Compact with Texans I TCEQ Homeland Security I Contact Us
Statewide Links: Texas.gov I Texas Homeland Security I TRAIL Statewide Archive I Texas Veterans Portal
® 2002-2013 Texas Commission on Environmental Quality
tps://www3.tceq.texas.gov/epay/Index.cfm7fuseactIon-recelpts.voucher_detall&userid-193234&pmt_ld-170376&voucher_num_txt=218256 Page 1 of
Its
TXR 15
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at
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LARGE CONSTRUCTION SITE NOTICE
FOR THE
Texas Commission on Environmental Quality (TCEQ)
Storniwater Program
TPDES GENERAL PERMIT TXR150000
"SECONDARY OPERA TOR " NOTICE
This notice applies to secondary operators of construction sites operating under Part II.E.3. of the
TPDES General Permit Number TXR150000 for discharges of stormwater runoff from construction
sites equal to or greater than five acres, including the larger common plan of development. The
information on this notice is required in Part 11LD.2. of the general permit. Additional information
regarding the TCEQ stormwater permit program may be found on the inlernet at:
htlp://www.tccconstruction,html
Site -Specific TPDES Authorization Number:
TXR 15
Operator Name:
I'rolo is L.P.
Contact Name and Phone Number:
Kyle Low 713.613.6943
Prologis Park One Twenty One
Thrp lir l:.x..l in Jw r`.ryrJ4 •ydl, IAuavrComrytTSl J:47�nlm xJ-970I1o11 I.njl Tlrtra,l.e rr.r:
nar>f:�:i�r>,,.n,l,,.k,y, ,rr,..11a7,rrchaaxo�Jn,a..t,h.,n,a,r.r4,,,.•n,�r.a4rn,,,�,r.:urr�a.lt1
Project Description: I'hlrsicul adclrc.cs urclescripliurr u�'Ihe
arl.i.trrmj.vJj rk rrar4•x.,tiar.war, jrntrn•inlrt.arjnn.xad arra: atnwhJrkrinj a.nuraunr•
Jll.,rr rrrJ l'awrxhiaav is .•,r r�i Lunen al l{YI:I Jrn r 4nrr .1tl.0 latitir��rr 1.�1. a.IWrc,lniitin
'�'a� ,�� r
,4ile .1 IC)CLiIIUII. CIIICI C\'l/II1ClIC'LI,S'ICII'l dale Lilr[ll,iUlC('ICCI L'
', IILI
Ilv,r.prrl)lrwiu.I the jWjerl linaAl•ru[x1i:ilriliMi.rrJleal ]IINI tirtr
"HEl.Jl,rarn rrJ sYV.rr...41.11rnW4,lvin<imiNJW tvtr jwyr,fwl Wala,lklinjxra, x'ark r••MJnrrr,
rtna,a,.n,ir.r.r,ants, Irra,nr,l. rd alrn,Jnlrar•,rv,,r,arJr{erre a, rk n:,.lrr.'I.rn aarnm
elute, or dale thm disturbed soils mill he .vMhdi_ed.
nlcgwre, a4nlan W r, nxww'w+� maun>rp t avvrnr al,t, luwlrr, ntarl.nrr. Nla'r,<k I
Est. Start Date: 9/15/14 Est Comp Date: 10/15/14
Location of Storinwater Pollution Prevention Plan (SWP3):
Earth Basics Contracting corp,
4012Galewn Dr Ste I.&On-site
Colleyvillc,q 76034
For Large Construction Activities Authorized Under Pant II.E.3, (Obtaining Authorization to Discharge)
the fgllowing certification must be completed:
Pritllyd Name I'orsun C•mnpletinj! This C•ettilicalion) rcrlil'y [little)
penally ol• 111%%, that 1 h;tve read and undcrswild till: eligibility requirement.% for el[liming on aullwri7nlinn ander furl II.I{.3. of
TPIWS Cic•naml Pencil TNR 150000 mid agree to cuntply with the terms ol•this permil. A stortmwater pollution III.Vwnliott
plan hos bec[l developed and will he ingllentented prior Io comhuclion. occonliii to liemlil rcgnitemcods. A ropy ol•Ihis
xigiled noliee is Supplied to the operator (1l• the h•I5:1 il•diseharges enter ;ut 'VIS4. I ant wore Iltere aw sigmilieanl pcnallies lin
providing fdse inliunlation or An conducting mna[lIhoriied discharges, including the ptissihihiv Ill' litre rind imprisonment li)r
kuo\eimg violations.
Signature and Title V P , to q �� 1
Must bc ml n deer 01 the company��
Complete fowl and notify helow when dual stahi►imflan has been acheived.
City of Coppell Utile Noth•C• kenl(wed
Emrnlul.illDc mrlment
25. -,Parkway B'vd PIIS! upenifor uulified per Perri
Coppell,TY 75019
SWP3 Certification Statement
Storm Water Pollution Prevention Plan Certification
Certification Statement
Project Name Prologis Park One Twenty One - Coppell
This certification is prepared for compliance with the General Permit to Discharge Waste under provisions of Section 402 of the
Clean Water Act and Chapter 26 of the Texas Water Code and may be used in the Storm Water Pollution Prevention Plan (SWP3).
All parties that either individually, or taken logether, meet the definition of "operator," must be permitted and sign a SWP3
certification. Each of these parties must have separate and distinct TPDES permit numbers (e.g. a separate permit is typically needed
for each Owner/Developer, General Contractor, and/or Builder). This form was prepared as a guideline and it is nota required form
for use with the permit. This information may be displayed in alternative form or forntnts within guidelines set forth in the permit.
"I 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."
PERMIT N
OPERATOR NAME
SI U F o
DATE NAME PRINTED
TXR15
Earth Basics Contracting Cot p.
���/ 711— —
TXR15
Prologis. L.P.
a 1�1
*Persons signing this certification must do so in compliance with the signatory requirements of the permit as found at Part V1I.6. of
the permit:
For a corporation: by a responsible corporate officer. This means a President, Vice -President, Secretary, Treasurer, Manager of one
or more facilities employing 250+ persons, or Manager for expenditures exceeding $25,000,000 (in 2ud Quarter 1980 dollars)).
For a partnership or sole proprietorship: by a general partner or the proprietor.
For n Municipality, State, Federal, or other public agency: a principal executive officer or ranking elected official.
P<'LI l:;iau n>_mxaerYrOr7DS hlre"wk Air Coppdght 431014 P.jst C—pli.,—.LLC All Rights Ramvd. M,228.1586
Delegation of Authority
"Executive Director"
Storm Water & General Permits Team; MC -228
P.O. Box 13087
Austin, Texas 78711-3087
TPDES Storm Water General Permit No.
Delegating an "Authorized Representative"
Project Name Prologis Park One Twenty One - Coppell
Dear Director:
This letter serves to designate either a person or specifically described position as an authorized person for
signing reports, storm water pollution prevention plans, certifications or other information requested by the Director
or required by the permit. This authorization cannot be used for signing an TPDES permit application (e.g. Notice
of Intent (NOI)) in accordance with 30 TAC Section 305.128. The following person or position is hereby authorized
to sign reports, plans or certifications other than the NOI application:
A representative of Project Compliance, LLC - 7 Day inspections
By signing this authorization, I confirm that I meet the following requirements to make such a designation
as set forth in 30 TAC Section 305.128.
(1) For a corporation, the application shall be signed by a responsible corporate officer. For purposes of this paragraph, a
responsible corporate officer means a president, secretary, treasurer, or vice-president or the corporation in charge of principal business
tinction, or any other person who performs similar policy or decision-making functions for the corporation; or the manager of one or more
manufacturing, production, or operating facilities employing more than 250 persons or having gross annual sales or expenditures
exceeding $25 million (in second-quarter 1980 dollars), if authority to sign documents has been assigned or delegated to the manager in
accordance with corporate procedures. Corporate procedures governing authority to sign permit or post -closure order applications may
provide for assignment or delegation to applicable corporate positions Father than to specific individuals.
(2) For a partnership or sole proprietorship, the application shall be signed by a general partner or the proprietor, respectively.
"I 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 oil 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."
PERMIT N
OPERATOR NAME SI TU E +
DATE NAME PRINTED
TXR15
Earth Basics Contracting Corp.
TXR15
Prologis, L.P.
v
KA Uy;sw i iiaded/IUUU'c Cnp)n1ht 02014 Project Complimmc.r.LC All Riehl, Res and W 22 1-16