Low Rainfall Erosivity Waiver (LREW) forStormwater Discharges Associated with Construction Activity under TPDES General Permit (TXR150000)
IMPORTANT
- Usethe INSTRUCTIONStofillout eachquestioninthis form.
- Usethe CHECKLISTtomakecertain you filled out allrequired information.Incomplete applications will delay approval or result in automatic denial.
- Onceprocessed yourpermit authorization canbeviewed at:
ePERMITS
- Effective September 1, 2018, this paper form must be submitted to TCEQ with a completed electronic reporting waiver form (TCEQ-20754).
- To submit this form electronically, enter the following web address into your internet browser and follow the instructions:
RENEWAL
Note: A Waiver cannot be renewed after June 3, 2018.
Is this a renewal of an existing LREW?☐Yes☐No
If Yes, provide the authorization number here: TXRCWClick here to enter text.
NOTE: If an authorization number is not provided, a new number will be assigned.
SECTION 1OPERATOR (APPLICANT)
a)If the applicant is currentlyacustomer withTCEQ, what is theCustomerNumber (CN) issued tothis entity?
Click here to enter text.
b)What is theLegalNameof the entity(applicant)applying forthis waiver? (The legal namemust bespelled exactly as the name filed withtheTexas SecretaryofState, County,or inthe legaldocument forming the entity.)
Click here to enter text.
c)What is the contact information for the Operator (ResponsibleAuthority)?
Prefix (Mr. Ms. Miss):Click here to enter text.
First and Last Name:Click here to enter text.Suffix:Click here to enter text.
Title:Click here to enter text.Credentials:Click here to enter text.
Phone Number:Click here to enter text.Fax Number:Click here to enter text.
E-mail: Click here to enter text.
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Low Rainfall Erosivity Waiver under TXR150000
Mailing Address:Click here to enter text.
City, State, and Zip Code:Click here to enter text.
Mailing Information if outside USA:
Territory:Click here to enter text.
Country Code: Click here to enter text.Postal Code:Click here to enter text.
d)Indicatethetypeofcustomer:
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Low Rainfall Erosivity Waiver under TXR150000
☐Individual
☐Limited Partnership
☐General Partnership
☐Trust
☐Sole Proprietorship (D.B.A.)
☐Corporation
☐Estate
☐Federal Government
☐County Government
☐State Government
☐City Government
☐Other Government
☐Other:Click here to enter text.
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e)Is the applicant an independent operator?(If governmental entity, subsidiary, or part of a larger corporation, check“No”.)☐Yes ☐No
f)Number of Employees.Select the range applicable to your company.
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☐0-20
☐21-100
☐101-250
☐251-500
☐501 or higher
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Low Rainfall Erosivity Waiver under TXR150000
g)CustomerBusiness Taxand Filing Numbers:(Requiredfor Corporations andLimited Partnerships.NotRequiredforIndividuals, Government, or SoleProprietors.)
StateFranchiseTaxIDNumber:Click here to enter text.
FederalTaxID:Click here to enter text.
Texas Secretary of StateCharter (filing)Number:Click here to enter text.
DUNSNumber(if known):Click here to enter text.
SECTION 2APPLICATION CONTACT
This individual will be contacted if TCEQ needs additionalinformationregarding this application.
Is the applicationcontactthesame as the applicant identified above?
☐Yes, go to Section 3
☐No, complete this section
Prefix(Mr. Ms. Miss):Click here to enter text.
First and Last Name:Click here to enter text.Suffix:Click here to enter text.
Title:Click here to enter text.Credential:Click here to enter text.
OrganizationName:Click here to enter text.
Phone Number:Click here to enter text.FaxNumber:Click here to enter text.
E-mail:Click here to enter text.
Mailing Address:Click here to enter text.
InternalRouting(MailCode, Etc.):Click here to enter text.
City, State, and Zip Code:Click here to enter text.
Mailing InformationifoutsideUSA:
Territory:Click here to enter text.
CountryCode:Click here to enter text.PostalCode:Click here to enter text.
SECTION 3REGULATED ENTITY (RE) INFORMATION FOR THE PROJECT OR SITE
a)If this is an existing permitted site, what is the Regulated EntityNumber (RN) issued to the site?RNClick here to enter text.
(Refer to Section 3.a) of the Instructions)
b)Nameofprojector site(the name knownbythecommunitywhereit’s located):Click here to enter text.
c)In your own words, briefly describe the type of construction occurring at the regulated site(residential, industrial, commercial, or other):Click here to enter text.
d)Countyor Counties (if located in more than one):Click here to enter text.
e)Latitude:Click here to enter text.Longitude:Click here to enter text.
f)Site Address/Location
If the site has a physical address such as 12100 Park 35 Circle, Austin, TX 78753, complete Section A.
If the site does not have a physical address, provide a location description inSection B. Example: located on the north side of FM 123, 2 miles west of the intersection of FM 123 and Highway 1.
Section A:
Street Number and Name:Click here to enter text.
City, State, and Zip Code:Click here to enter text.
Section B:
Location Description:Click here to enter text.
City (or city nearest to) where the site is located:Click here to enter text.
Zip Code where the site is located:Click here to enter text.
SECTION 4GENERAL CHARACTERISTICS
a)Is theproject/site located onIndianCountryLands?
☐Yes, do not submit this form. You must obtain authorization through EPA Region 6.
☐No
b)Is your construction activity associated withafacilitythat, whencompleted, would be associated withthe exploration,development, orproductionofoil or gas or geothermal resources?
☐Yes. Note: The construction stormwater runoff may be under jurisdiction of the Railroad Commission of Texas and may need to obtain authorization through EPA Region 6.
☐No
c)What is thePrimaryStandard IndustrialClassification (SIC)Codethat bestdescribes the construction activitybeing conducted atthesite?Click here to enter text.
d)What istheSecondarySIC Code(s), if applicable?Click here to enter text.
e)What is thetotal numberof acres disturbed?Click here to enter text.
f)Will the construction site disturb an area of 5 or more acres, or is the construction site part of a larger common plan of development or sale that would disturb an area of 5 or more acres?
☐Yes, do not submit this form. Thisproject or sitedoes not qualifyfor awaiver.
☐No
g)What is theestimated start date of the project?Click here to enter text.
h)What is theestimated end date of the project?Click here to enter text.
i)Does theconstructionsitehave anR-Factor of less than 5, based onits locationand timeframefor completion?
☐Yes
☐No, do not submit this form. Thisproject or sitedoes not qualifyfor awaiver.
j)What is the nameof thefirstwater body(ies)to receivethestormwaterrunoff orpotential runoff from thesite?Click here to enter text.
k)What is thesegment number(s) oftheclassifiedwater body(ies)that thedischargewill eventuallyreach?Click here to enter text.
l)Is thedischargeinto a Municipal Separate Storm Sewer System(MS4)?
☐ Yes☐ No
If Yes,providethe nameof the MS4 operator:Click here to enter text.
Note:Thegeneralpermit requires you tosend acopyof thisLREW form totheMS4 operator.
m)Is thedischargeorpotentialdischargewithintheRecharge Zone, Contributing Zone, or Contributing ZonewithintheTransition Zone of theEdwardsAquifer,as defined in30TAC Chapter 213?
☐Yes,complete the certificationbelow.
☐No, go to Section 5.
I certifythat acopyof theTCEQ approved Planrequired bytheEdwards Aquifer Rule (30TAC Chapter 213)iseither included or referenced intheStormwaterPollution PreventionPlan). ☐Yes
SECTION 5CERTIFICATION
a)I certify that I have obtained a copy and understand the terms and conditions of theConstruction General Permit (TXR150000). ☐Yes
b)I certify that the full legal name of the entity applying for this permit has been provided and is legally authorized to do business in Texas. ☐Yes
c)I certify that the activities at this site qualify for coverage under the Construction General Permit (TXR150000). ☐Yes
d)I understand that construction activities at this site shall occur within a time period in which the erosivity factor (R Factor) is less than 5, and if construction activities continue past the end date provided in this form, a new R factor must be calculated based on the initial start date and a new end date. If the R Factor is greater than or equal to 5, all applicable sections of the general permit must be followed. ☐Yes
e)I understand that a Notice of Termination (NOT) must be submitted when this authorization is no longer needed. ☐Yes
Operator Certification:
Operator Signatory Name:Click here to enter text.
Operator Signatory Title:Click here to enter text.
I certifyunder penaltyof law that this document and all attachments wereprepared under my direction or supervisionin accordancewithasystem designed toassurethat qualified personnel properlygather and evaluatetheinformationsubmitted.Based onmyinquiryofthepersonor persons whomanagethesystem,or thosepersons directlyresponsiblefor gathering the information,theinformationsubmitted is, tothebestof my knowledge and belief, true, accurate, andcomplete.I am awarethere aresignificant penalties for submitting false information, includingthepossibilityof fine and imprisonment for knowing violations.
I further certifythat I amauthorizedunder 30Texas AdministrativeCode305.44 to sign and submit thisdocument, and canprovidedocumentationin proofof suchauthorizationupon request.
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LOW RAINFALL EROSIVITY WAIVERCHECKLIST (TXR150000)
Usethis checklistto besureyoucomplete everything!Missing information may result in denial of waiver coverage under the general permit.
RENEWAL
☐For renewalof an existing authorization, the authorization number is provided.
OPERATORINFORMATION
☐CustomerNumber (CN)issuedbyTCEQCentral Registry
☐Legal name as filed todobusiness inTexas(CallTXSOS512-463-5555)
☐Name and titleof responsible authoritysigning the application
☐Phone number and e-mail address
☐Mailing address is completeverifiablewithUSPS.
☐Typeofoperator (entitytype). Is the applicant anindependentoperator?
☐Number of employees
☐Forcorporationsorlimited partnerships –TaxIDand SOSfiling numbers
☐Applicationcontact is completeaddress isverifiablewithUSPS
REGULATED ENTITY(RE)INFORMATIONONPROJECT ORSITE
☐Regulated EntityNumber (RN)(ifsiteis alreadyregulated byTCEQ)
☐Site/projectname and construction activity description
☐County
☐Latitude and longitude
☐Site Address/Location.Donot usearuralroute or post office box.
GENERALCHARACTERISTICS
☐IndianCountryLands –Thefacilityis not onIndianCountryLands.
☐Construction activitynot related tofacility associatedwith oil, gas, or geothermalresources
☐Standard IndustrialClassification (SIC)Code
☐Acresdisturbed isprovided
☐Acresdisturbed for site or commonplanof development is <5acres
☐EstimatedStart and EndDates of the project
☐Is the RFactor <5
☐Receivingwater body(ies)
☐Segment number(s)
☐MS4 operator
☐Edwards Aquifer Rule
CERTIFICATION
☐Certificationstatementshavebeenchecked indicating “Yes”
☐Signaturemeets 30Texas AdministrativeCode (TAC) 305.44 and is original.
TCEQ-20064 Checklist (3/9/2018)Page 1
Instructions for Low Rainfall Erosivity Waiver(LREW) for
StormwaterDischargesAssociatedwithConstruction ActivityunderTPDES GeneralPermit (TXR150000)
GENERAL INFORMATION
Where to Send theWaiver:
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Instructions for Low Rainfall Erosivity Waiver under TXR150000
By RegularMail:
TCEQ
StormwaterProcessing Center (MC228)
P.O. Box 13087
Austin, Texas 78711-3087
By Overnight/ExpressMail:
TCEQ
StormwaterProcessing Center(MC228)
12100Park35Circle
Austin, TX78753
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Instructions for Low Rainfall Erosivity Waiver under TXR150000
TCEQ Contact List
Application–status andform questions:512-239-3700, echnical questions: 512-239-4671, nvironmentalLaw Division: 512-239-0600
Records Management -obtaincopiesof forms:512-239-0900
Reports from databases(as available):512-239-DATA (3282)
Cashier’s office:512-239-0357 or 512-239-0187
Waiver Process
When your Waiverisreceived bytheprogram, theform willbeprocessedas follows:
- Administrative Review:Eachitemontheform willbereviewed for acompleteresponse.In addition, the operator’s legal namemust beverified withTexas Secretaryof State as validand active(if applicable).The address(es)ontheform must beverified with the USPostal service as receivingregular maildelivery.Do not give anovernight/expressmailing address.
- Notice of Deficiency:If anitem is incompleteor not verifiable as indicated above, a notice of deficiency(NOD)willbemailed tothe operator.The operator willhave30days to respond totheNOD.Theresponsewillbereviewed for completeness.
- Acknowledgment of Coverage:AnAcknowledgment Certificatewillbemailed tothe operator.This certificate acknowledges coverageunder thegeneralpermit.
or
Denial of Coverage:If the operator failsto respondtotheNODortheresponseis inadequate, coverageunder thegeneralpermit maybedenied.If coverageis denied, the operator willbe notified.
GeneralPermit(Your Permit)
For LREWs submitted electronically through ePermits, construction activities are provisionallywaived from theotherwise applicablerequirementsof this generalpermit immediately following confirmation of receipt of the LREW form by the TCEQ.
ForpaperLREWs,construction activities are provisionallywaived from theotherwise applicablerequirementsof this generalpermit 7 days after a completed LREW is postmarked for deliverytotheTCEQ.
Coverage ends ontheEstimatedEnd Date as entered intheLREW form.
Youshouldhaveacopy of your generalpermit whensubmitting your application.You mayview and print yourpermit forwhichyou areseeking coverage,ontheTCEQweb site keyword TXR150000.
Change inOperator
An authorizationunder thegeneralpermit is not transferable.If the operatorof theregulated entitychanges,thepresent permitteemustsubmit aNoticeofTerminationand the newoperator must submit aNoticeofIntentor Waiver.TheNOT and NOI/Waivermust be submitted nolater than 10days prior tothechangein Operator status.
TCEQCentral Registry CoreData Form
TheCoreDataForm hasbeenincorporated intothis form.Donot send aCoreDataFormto TCEQ.After final acknowledgment ofcoverageunder thegeneralpermit,the program willassignaCustomer Number and Regulated EntityNumber, if one has not already been assigned to this customer or site.
For existing customers and sites, youcanfind theCustomer Number and Regulated Entity Number by entering the following web address into your internet browser: cansearchby your permit number, the Regulated Entity (RN) number, or the Customer Number (CN). If you do not know these numbers, you can select “Advanced Search” to search by permittee name, site address, etc.
TheCustomer (Permittee)is responsiblefor providing consistent informationtotheTCEQ, and for updating allCNandRNdatafor all authorizations aschangesoccur.Forthis permit, a Noticeof Changeform mustbesubmitted tothe program area.
INSTRUCTIONS FOR FILLING OUT THE WAIVER FORM
Renewal of General Permit.Dischargers holding active authorizationsunder the expired GeneralPermit arerequired tosubmit aWaivertocontinuecoverage.The existing permit number is required.If thepermit number is notprovidedor has beenterminated, expired,or denied, a new permit number willbeissued.
Section 1.OPERATOR (APPLICANT)
a)Customer Number (CN)
TCEQ’s CentralRegistrywill assign eachcustomer a number thatbegins withCN, followedby ninedigits.The is not a permit number, registration number, or license number.
If the applicant is an existing TCEQ customer, the Customer Number is available at the following website: If the applicant is not an existing TCEQ customer, leave the space for CN blank.
b)Legal Name
Providethecurrent legal nameof theapplicant.Thenamemust be provided exactly as filed withtheTexas Secretary of State(SOS),oronother legal documents forming the entity, as filed inthecounty. You maycontacttheSOSat 512-463-5555, formoreinformationrelated tofiling inTexas.If filed inthecounty, providea copyof the legaldocuments showingthelegal name.
c)Contact Information for the Applicant (Responsible Authority)
Provideinformation about personsigning the application in Section5)Certification. This person is also referred to as the Responsible Authority.
Provideacompletemailing addressfor receiving mailfromtheTCEQ.Theaddress mustbe recognized bytheUSPostalServiceYou may verify the address on the following website:
The phone number should provide contact to the applicant.
The fax number and e-mail address are optional and should correspond to the applicant.
d)Type ofCustomer (Entity Type)
Checkonlyone boxthat identifies thetypeof entity.Usethedescriptionsbelow toidentifytheappropriate entitytype.Notethattheselected entitytype alsoindicates the namethat mustbe provided as an applicant for apermit, registrationor authorization.
Individual
An individual is a customer who has not established a business, but conducts an activity that needs to be regulated by the TCEQ.
Partnership
A customer that is established as a partnership as defined by the Texas Secretary of State Office (TX SOS). If the customer is a ‘General Partnership’ or ‘Joint Venture’ filed in the county (not filed with TX SOS), the legal name of each partner forming the ‘General Partnership’ or ‘Joint Venture’ must be provided. Each ‘legal entity’ must apply as a co-applicant.
Trust or Estate
A trust and an estate are fiduciary relationships governing the trustee/executor with respect to the trust/estate property.
Sole Proprietorship (DBA)
A sole proprietorship is a customer that is owned by only one person and has not been incorporated. This business may:
- be under the person’s name
- have its own name (doing business as or DBA)
- have any number of employees.
If the customer is a Sole Proprietorship or DBA, the ‘legal name’ of the individual business ‘owner’ must be provided. The DBA name is not recognized as the ‘legal name’ of the entity. The DBA name may be used for the site name (regulated entity).
Corporation
A customer that meets all of these conditions:
- is a legally incorporated entity under the laws of any state or country
- is recognized as a corporation by the Texas Secretary of State
- has proper operating authority to operate in Texas
The corporation’s ‘legal name’ as filed with the Texas Secretary of State must be provided as applicant. An ‘assumed’ name of a corporation is not recognized as the ‘legal name’ of the entity.
Government
Federal, state, county, or city government (as appropriate)
The customer is either an agency of one of these levels of government or the governmental body itself. The government agency’s ‘legal name’ must be provided as the applicant. A department name or other description of the organization is not recognized as the ‘legal name’.
Other
This may include a utility district, water district, tribal government, college district, council of governments, or river authority. Provide the specific type of government.
e)Independent Entity
Check Noif this customer is asubsidiary,partof alarger company, or is agovernmental entity.Otherwise, checkYes.
f)Number of Employees
Checkone boxtoshow the numberof employees for this customer’s entirecompany, at alllocations.This is not necessarilythe numberof employees at thesite named inthe application.
g)Customer BusinessTaxandFilingNumbers
These arerequired for Corporations and LimitedPartnerships.These are not required forIndividuals,Government, and SoleProprietors.
State Franchise TaxID Number
Corporations and limitedliabilitycompanies thatoperateinTexas areissued afranchisetax identification number. Ifthis customer is acorporation or limited liabilitycompany, enter this number here.
Federal TaxID
Allbusinesses, except forsomesmallsoleproprietors, individuals, orgeneralpartnerships shouldhaveafederaltaxpayer identification number (TIN). Enter this numberhere. Use no prefixes, dashes, or hyphens. Sole proprietors, individuals, or generalpartnershipsdonot need to provideafederaltaxID.
TXSOS Charter (filing)Number
Corporations and Limited Partnerships required to register withtheTexasSecretaryof State areissued acharteror filing number.You may obtainfurther informationbycalling SOSat512-463-5555.
DUNS Number
MostbusinesseshaveaDUNS(DataUniversal Numbering System)number issuedbyDun and Bradstreet Corp.If this customerhasone, enter it here.