SS9901-CS050125CONSTRUCTION SITE NOTICE
FOR THE
Texas Commission on Environmental Quality (TCEQ)
Storm Water Program
TPDES GENERAL PERMIT TXR150000
The following information is posted in compliance with Part II.D.2. of the TCEQ General Permit Number
TXR150000 for discharges of' storm water runoff from construction sites. Additional information regarding the
TCEQ storm water permit program may be found on the internet at:
www.tnrcc.state.tx.us/permitting/waterperm/wwperm/tpdestorm
Contact Name and Phone Number: Can-Fer Construction Company
972-484-4344
Deforest & Sandy Lake Lift Station 600 Deforest Road Coppell, TX
Proiect Description: 75019
(Physical address or description of the site's
location, estimated star~ date and projected end
date, or date that disturbed soils will be
stabilized)
Location of Storm Water Pollution Jobsite Office Trailer
>revention Plan:
For Construction Sites Authorized Under Part I I.D.2. (Obtaining Authorization to Discharge) the following
certificati0n must be completed:
John Cantu (Typed or Printed Name Person Completmg rhb Certification) certify under penalty of
law that I have read and understand the eligibility requirements for claiming an authorization under Part ll.D.2, of
TPDES General Permit TXR150000 and agree to comply with the terms of this permit. A storm water pollution
prevention plan has been developed and implemented according to permit requirements. A copy of this signed
notice is supplied to the operator of the MS4 if discharges enter an MS4 system. I mn aware there are significant
penalties for providing false information or for conducting unauthorized discharges, including the possibility of fine
and ~ent fgM~-~ing vj~lations. __
Signa'(ure and Title Date
Transmittal Cover Sheet
Detailed, Grouped by Each Transmittal Number
Deforest & Sandy Lake Lift Station Project # 04-44 Can-Fer Construction Company, Inc.
Tel: Fax:
Transmitted fo
Kenneth Griffin
City of Coppell
255 Parkway Boulevard
Coppell, TX 75019
Tel: 972-304-7090
Fax: 972-304-3570
Transmitted By
Todd Hoff
Can-Fer Construction Company, Inc
11031 Grissom Lane
Dallas, TX 75229
Tel: 972484~4344
Fax: 972-484~223
Package Transmitted For
information
Delivered Via
US Mail
Tracking Number
Item # Qty Item Reference Des~ription Notes
001 1 0 TCEQ Construction S~te Notice
CC: Company Name Contact Name Copies Notes
Status
Remarks
Signed Date
PrologLT Pdntedon: 2/14/2005 c:\ ~coppelldeforest&sandylakeliffstation,pmd Page1 of 1