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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



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):


Waste Management of Texas, Inc.

600127856

2411 FM 963 Attn: Tim Champagne


(512) 731-9768

[email protected]

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

[email protected]

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 County (CN600769129)

220 South Pierce Street


(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.


THIS PAGE IS NOT APPLICABLEBurnet Transfer Station 11/26/2018

40035

Form

Permit/Registration Name Change/Transfer Modification

Required Attachments Attachment No.



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Attachment C

Closure Cost Estimate



Attachment D

Registration Transfer Affidavits



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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Attachment F

Legal Description



Attachment G

Legal Authority of Transferee



Attachment H

Evidence of Competency



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



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



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



Attachment J

Property Owner Affidavit