Burnet Transfer Station, Burnet CountyMSW Registration No. 40035
GR6795/ Burnet Transfer Station – Registration Transfer
Attachment A
Core Data Form – TCEQ Form 10400
TCEQ-10400 (04/15) Page 1 of 2
TCEQ Core Data FormFor detailed instructions regarding completion of this form, please read the Core Data Form Instructions or call 512-239-5175.
SECTION I: General Information 1. Reason for Submission (If other is checked please describe in space provided.)
New Permit, Registration or Authorization (Core Data Form should be submitted with the program application.)
Renewal (Core Data Form should be submitted with the renewal form) Other Registration Transfer2. Customer Reference Number (if issued) Follow this link to search
for CN or RN numbers in Central Registry**
3. Regulated Entity Reference Number (if issued)
CN 600127856 RN 102218286
SECTION II: Customer Information4. General Customer Information 5. Effective Date for Customer Information Updates (mm/dd/yyyy) 12/01/2018
New Customer Update to Customer Information Change in Regulated Entity Ownership Change in Legal Name (Verifiable with the Texas Secretary of State or Texas Comptroller of Public Accounts)
The Customer Name submitted here may be updated automatically based on what is current and active with the Texas Secretary of State (SOS) or Texas Comptroller of Public Accounts (CPA).6. Customer Legal Name (If an individual, print last name first: eg: Doe, John) If new Customer, enter previous Customer below:
Waste Management of Texas, Inc. 7. TX SOS/CPA Filing Number0022300000
8. TX State Tax ID (11 digits)
175122352889. Federal Tax ID (9 digits)
10. DUNS Number (if applicable)
11. Type of Customer: Corporation Individual Partnership: General Limited
Government: City County Federal State Other Sole Proprietorship Other: 12. Number of Employees
0-20 21-100 101-250 251-500 501 and higher13. Independently Owned and Operated?
Yes No14. Customer Role (Proposed or Actual) – as it relates to the Regulated Entity listed on this form. Please check one of the following:
Owner Operator Owner & Operator Occupational Licensee Responsible Party Voluntary Cleanup Applicant Other:
15. Mailing Address:
2411 FM 963 Burnet, TXAttn: Tim Champagne City Burnet State TX ZIP 78611 ZIP + 4 6212
16. Country Mailing Information (if outside USA) 17. E-Mail Address (if applicable)
[email protected] 18. Telephone Number 19. Extension or Code 20. Fax Number (if applicable)
( 512 ) 731-9768 ( ) -
SECTION III: Regulated Entity Information21. General Regulated Entity Information (If ‘New Regulated Entity” is selected below this form should be accompanied by a permit application)
New Regulated Entity Update to Regulated Entity Name Update to Regulated Entity Information
The Regulated Entity Name submitted may be updated in order to meet TCEQ Agency Data Standards (removal of organizational endings such as Inc, LP, or LLC.)22. Regulated Entity Name (Enter name of the site where the regulated action is taking place.)
Burnet Transfer Station
TCEQ Use Only
Burnet Transfer Station, Burnet CountyMSW Registration No. 40035
GR6795/ Burnet Transfer Station – Registration Transfer
Attachment B
Registration Modification Form – TCEQ Form 20650
Form
Facility Name: Permittee/Registrant Name: MSW Authorization #: Initial Submittal Date: Revision Date:
Texas Commission on Environmental QualityPermit/Registration Modification and Temporary Authorization
Application Form for an MSW Facility
1. Reason for Submittal
2. Authorization Type
3. Application Type
4. Application Fees
5. Application URL
6. Confidential Documents
Burnet Transfer StationWaste Management of Texas, Inc.
4003511/26/2018
■
582EA000322628
www.wm.com/wm/permits-texas/permits.jsp
■
Form
7. General Facility Information
8. Facility Type(s)
9. Description of the Revisions to the Facility
Burnet Transfer Station 11/26/201840035
Burnet Transfer Station
40035
RN102218286
2411 FM 963
Burnet Burnet TX 78611
(512) 756-6318
N 30° 47' 26.85" W 98° 12' 44.07"
Registration Modification Request with Notice - Registration Transfer.
The request is submitted as a “registration modification with notice” under theprovisions of 30 TAC §305.70(k) [name changes or transfers of municipal solid wastepermits or registrations]. The authorization is requested to transfer the operator fromBFI Transfer Systems of Texas, LP (CN 605234400) to Waste Management of Texas,Inc. (CN 600127856).
Form
10. Facility Contact Information
Site Operator (Permittee/Registrant) Name:
Operator Name1:
Consultant Name (if applicable):
Agent in Service Name (required only for out-of-state):
Burnet Transfer Station 11/26/201840035
Waste Management of Texas, Inc.
600127856
2411 FM 963 Attn: Tim Champagne
Burnet Burnet TX 78611
(512) 731-9768
22300000
Same as Site Operator (Registrant)
Geosyntec Consultants, Inc.
1182
8217 Shoal Creek Blvd, Suite 200 Attn: Scott Graves
Austin Travis TX 78757
(512) 451-4003
CT Corporation System
1999 Bryan Street
Dallas Dallas TX 75201
(214) 979-9450
Not Available (N/A)
Form
11. Ownership Status of the Facility
Owner Name:
Burnet Transfer Station 11/26/201840035
■
Burnet County (CN600769129)
220 South Pierce Street
Burnet Burnet TX 78611
(512) 756-5406
County Government
Form
Permit/Registration Modification with Public Notice
Required Attachments Attachment No.
Additional Attachments as Applicable- Select all those apply and add as necessary
THIS PAGE IS NOT APPLICABLEBurnet Transfer Station 11/26/2018
40035
Form
Permit/Registration Modification without Public Notice or TA
Required Attachments (for Modifications only) Attachment No.
Additional Attachments as Applicable- Select all those apply and add as necessary
THIS PAGE IS NOT APPLICABLEBurnet Transfer Station 11/26/2018
40035
Form
Permit/Registration Name Change/Transfer Modification
Required Attachments Attachment No.
Additional Attachments as Applicable- Select all those apply and add as necessary
Burnet Transfer Station 11/26/201840035
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E
Burnet Transfer Station, Burnet CountyMSW Registration No. 40035
GR6795/ Burnet Transfer Station – Registration Transfer
Attachment C
Closure Cost Estimate
Burnet Transfer Station, Burnet CountyMSW Registration No. 40035
GR6795/ Burnet Transfer Station – Registration Transfer
Attachment D
Registration Transfer Affidavits
Burnet Transfer Station, Burnet CountyMSW Registration No. 40035
GR6795/ Burnet Transfer Station – Registration Transfer
Attachment E
Application Fee
11/26/2018 TCEQ ePay
https://www3.tceq.texas.gov/epay/index.cfm?fuseaction=receipts.pmt_detail&userid=389798&pmt_id=318089&message=epaysuccess 1/1
Trace Number:Date:
Payment Method:Amount:
ePay Actor:Actor Email:
IP:
Name:Company:Address:
Phone:
Your transaction is complete. Thank you for using TCEQ ePay.
Note: It may take up to 3 working days for this electronic payment to be processed and be reflected in theTCEQ ePay system. Print this receipt and the vouchers for your records. An email receipt has also been sent.
Transaction Information
582EA00032262811/26/2018 12:44 PMCC - Authorization 000079870P$150.00Alexander C [email protected]
Payment Contact Information
Alexander C BrewsterGeosyntec Consultants8217 Shoal Creek Suite 200, Austin, TX 78757512-354-3283
Cart Items
Click on the voucher number to see the voucher details.
Voucher Fee Description AR Number Amount394137 NONHAZARDOUS WASTE PERMIT - NEW, AMENDMENTS & MODIFICATIONS $100.00
394138 30 TAC 305.53B HWP NOTIFICATION FEE $50.00
Total fees for transaction: $150.00
Note: It may take up to 3 working days for this electronic payment to be processed and be reflected in theTCEQ ePay system. Print this receipt for your records.
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Burnet Transfer Station, Burnet CountyMSW Registration No. 40035
GR6795/ Burnet Transfer Station – Registration Transfer
Attachment F
Legal Description
Burnet Transfer Station, Burnet CountyMSW Registration No. 40035
GR6795/ Burnet Transfer Station – Registration Transfer
Attachment G
Legal Authority of Transferee
Burnet Transfer Station, Burnet CountyMSW Registration No. 40035
GR6795/ Burnet Transfer Station – Registration Transfer
Attachment H
Evidence of Competency
Burnet Transfer Station, Burnet CountyMSW Registration No. 40035
GR6795/ Burnet Transfer Station – Registration Transfer
Attachment I
Land Ownership Map and Landowners List
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BURNET TRANSFER
STATION
PERMIT BOUNDARY
1/4 MILE RADIUS FROM PERMIT BOUNDARY
LAND OWNER PARCEL BOUNDARY (NOTE 1)
LAND OWNERSHIP ID (NOTE 2)
LEGEND
N
6
0 400' 800'
SCALE IN FEET
NOTES:
1. LATEST AVAILABLE (MARCH 2016) LAND OWNERSHIP PARCEL BOUNDARIES
SHOWN ON THIS DRAWING WERE OBTAINED FROM THE BURNET COUNTY
APPRAISAL DISTRICT REAL PROPERTY RECORDS.
2. THE LAND OWNERSHIP ID NUMBERS SHOWN ON THIS DRAWING WERE
GENERATED BY GEOSYNTEC FOR PROPERTIES WITHIN 1/4 - MILE OF THE
PERMIT BOUNDARY. THE LAND OWNER'S LIST THAT ACCOMPANIES THIS MAP
(PART I, APPENDIX IB) IS KEYED TO THE PROPERTIES ON THIS MAP USING THIS
NUMBERING SYSTEM.
3. A SEARCH OF THE REAL PROPERTY APPRAISAL RECORDS FOR BURNET
COUNTY REVEALED NO LISTED MINERAL INTEREST OWNERS UNDER THE
FACILITY.
BURNET
COUNTY
WASTE MANAGEMENT OF TEXAS, INC.
SITE ADDRESS:
2411 FM 963
BURNET, TEXAS 78611
FIGURE
SURROUNDING LAND OWNERSHIP MAP
BURNET TRANSFER STATION MODIFICATION
PERMIT TRANSFER APPLICATION - MSW
AUTHORIZATION NO. 40035
NOVEMBER 2018
1
AUSTIN, TX
Burnet Transfer Station, Burnet CountyMSW Registration No. 40035
GR6795/ Burnet Transfer Station – Registration Transfer
Land Ownership Map and Landowners List
1 Earline A ZimmermanP.O. Box 484
Burnet, TX 78611
2 Burnet County Of220 S Pierce St RM 1
Burnet, TX 78611-3136
3 C/O Hill Country Recycling Corp (Leasee)P.O. Box 3040
Marble Falls, TX 78654-3077
4 C/O Allied Waste North America, Inc.P.O. Box 29246
Republic Services-Property Tax
Phoenix, AZ 85038-9246
5 Cindia Adams Hill Country Tire
P.O. Box 534
Burnet, TX 78611-0534
6 Burnet County Of220 S Pierce St RM 1
Burnet, TX 78611-3136
7 Barbara Bird1112 Country Road 200
Burnet, TX 78611-6129
8 Margaret N LangeP.O. Box 726
Burnet, TX 78611-0726
9 Kim A Miller2312 FM 963
Burnet, TX 78611
10 Roy A Etux Smith P.O. Box 1472
Burnet, TX 78611-7472
11 Billy Joe Havard695 W Odell St
Austin, TX 78752-2313
12 Mario C & Dora E GonzalezP.O. Box 68
Burnet, TX 78611
13 Rufio Palacios 108 Palacios LN
Burnet, TX 78611-6253
14 Vincente Etux Aldelfa Palacios114 Palacios LN
Burnet, TX 78611-6253
Burnet Transfer Station, Burnet CountyMSW Registration No. 40035
GR6795/ Burnet Transfer Station – Registration Transfer
Land Ownership Map and Landowners List (cont.)
15 Star Propane IncP.O. Box 929
Lampasas, TX 76550-0007
16 Howard James Benton303 4th St
Burnet, TX 78611-1030
17 Gary E Etux Linda Caldwell 3261 County Road 112
Burnet, TX 78611-5768
18 Chris Allen & Janet K ParkerP.O. Box 1236
Burnet, TX 78611-7236
19 Chris & Janet Parker3246 CR 112
Burnet, TX 78611
20 Ernest R Spiekermann3128 Country Road 112
Burnet, TX 78611-5769
21 Ernest R Spiekermann3128 County Road 112
Burnet, TX 78611-5769
22 Acuna Eustacia Castillo & Juana
1108 Windhaven Circle
Lewisville, TX 75057
23 Charles Kennedy WardenP.O. Box 67
Burnet, TX 78611
24 Billy Joe Havard605 W Odell St
Austin, TX 78752-2313
25 Janet M Wilde2509 FM 963
Burnet, TX 78611
Burnet Transfer Station, Burnet CountyMSW Registration No. 40035
GR6795/ Burnet Transfer Station – Registration Transfer
Attachment J
Property Owner Affidavit