Coppell Ind 2-PT040507 (2)Notice of Intent (NOI) ivr Storm Water Discharges TCEQ Office Use Only
s : Associated with Construction Activity under the TPDES Permit Number: TXR15•_•_ _ NO
` TPDES Construction General Permit (TXR950000) GIN Number: •_•_•_•_•_•;•_••
For hefp completing this applicabun, read the TXR150000 NOI Instructions
A. Construction Site Operator QNew ❑No Change Customer Reference Number. CN
Name. HILLWOOD CONSTRUCTION SERVICES _
Mailing Address: 5430 LBJ FREEWAY SUITE 800 City: DALLAS State: TX Zip Code. 75240
Country Mailing Information (if orrfside USA) Territory: Country Code: Postal Code:
Phone Number 972- 201 -2930 Extension. Fax Number: 97 2 - 201 -2929
E -mail Address: A44A11 • 0 N /LLW00/- 64
Type of Operator. ❑ Individual ❑ Sole Proprietorship - D.B.A. IN Partnership [] Corporation ❑ Federal Government
❑ State Government ❑ County Government ❑ City Government ❑ Other:
Independent Operator? ® Yes ❑ No Number of Employees: Q 0-20 ❑ 21 -100 ❑ 101 -250 ❑ 251.500 ❑ 501 or higher
Federal Tax ID: 752908860 State Franchise Tax ID Number. DUNS Number:
B. Billing Address
Name: HILLWOOD CONSTRUCTION SERVICES
Mailing Address: 5430 LBJ FREEWAY SUITE 800 City: DALLAS State: TX Zip Code: 75240
Country Mailing Information (doutside USA) Territory: Country Code: Postal Code:____
C. Project !Site Information NNew []No Change Regulated Entity Reference Number: RN
Name. TRADEPOINT BUSINESS PARK
Mailing Address: 5430 L13J FREEWAY SUITE 800 City. DALLAS State: TX Zip Code: 75240
Physical Address: NW CORNER ROYAL & BETHEL RD. City: COPPELL County: DENTON Zip Code:
Location Access Description: _
Latitude: 32 • 59 ' 30 " N Longitude. 97 • 1 30 " W Degrees ( °), Minutes I'), and Seconds ( ")
Latitude: Longitude: - Decimal Form
Standard Industrial Classification (SIC) code. Also, describe the construction activity at this site (do not repeat the SIC code).
Has a storm water pollution prevention plan been prepared as specified in the general permit (TXR 150000)? Q Yes p No
Estimated area of land disturbed (to the nearest acre): 60 Is the project I site located on Indian Country Lands? ❑ Yes ® No
Does this project I site discharge storm water into a municipal separate storm sewer system (MS-4)? El Yes ® No
If yes, provide the name of the MS4 operator:
Provide the name or segment number of the water body that receives storm water from this project i site
D. Contact - If the TCEO needs additional information regarding this application, who should be contacted?
Name: TOMMIE SMITH Title: SALES MANAGER
Phone Number: 940-648-3640 Extension: Fax Number. 9406403407
E -mail Address: TSMITH@TEXASENVIRO.COM
E. Payment Information - Check I Money Order Number. Name on Check I Money Order:
F. Certification
I certify under penaf yof law that this document was 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 in m
ration submitted is, to the best of my knowledge and belief, true, accurate, and mmpiete I am
aware there are significant penalties `nr submitting fat information, including the possibility of fine and imprisonment for knowing violations.
Construction Site Operator
Prefix: MR. First: JAM Middle: E. _
Last: LINDEN Suffix: Title: PRESIDENT
Signature: Date.
If you have quesUO)+s. to fill out t s or atxwt the storm water program, please contact us at (512) 239 -4671.
Individuals are entitled to uest and revie eir personal information that the agency gathers on its forms. 1 hey may also have any onars in their information
Corr 'we To review st information. contact us at (512) 239 -3282.
The ompleted NOI must be mailed to the following address Use the attached document to submit the $100
application fee. Please note that the NOI and application fee are submitted separately to different addresses.
Texas Commission on Environmental Quality
Storm Water & General Permits Team; MC - 228
P.O. Box 13087
Austin, Texas 78711 -3087
TCEO -20022 (05103) Pagel of 2