Form Tceq 10400 PDF Details

In the realm of environmental regulation and compliance, forms such as the TCEQ 10400, also known as the Core Data Form, serve a pivotal role in the organization and submission of crucial information to the Texas Commission on Environmental Quality (TCEQ). This detailed document is an essential part of the process for entities seeking permits, registrations, or authorizations, as well as those undergoing renewals or reporting changes in their operational or ownership details. With sections meticulously designed to gather general information, customer information, and details about the regulated entity, the form acts as a comprehensive dossier that aids the TCEQ in maintaining up-to-date records on entities that have an impact on the environment within Texas. Instructions accompanying the form emphasize its significance and offer guidance on how to properly complete it, ensuring that submissions are as accurate and thorough as possible. Whether it's a new application or updating existing information due to changes in ownership, legal name, or operational data, the form facilitates a structured channel for communication with the regulatory body, reinforcing the importance of compliance and environmental stewardship.

QuestionAnswer
Form NameForm Tceq 10400
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesTX, tceq, Preparer, E-Mail

Form Preview Example

TCEQ Core Data Form

TCEQ Use Only

For 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

 

2.

Attachments

 

Describe Any Attachments: (ex. Title V Application, Waste Transporter Application, etc.)

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

Customer Reference Number (if issued)

 

 

Follow this link to search

 

 

4. Regulated Entity Reference Number (if issued)

 

 

CN

 

 

 

 

for CN or RN numbers in

 

 

RN

 

 

 

 

 

 

Central Registry**

 

 

 

SECTION II: Customer Information

5. Effective Date for Customer Information Updates (mm/dd/yyyy)

6. Customer Role (Proposed or Actual) – as it relates to the Regulated Entity listed on this form. Please check only one of the following:

Owner

Occupational Licensee

Operator Responsible Party

Owner & Operator Voluntary Cleanup Applicant

Other:

7. General Customer Information

 

New Customer

 

Update to Customer Information

Change in Regulated Entity Ownership

 

Change in Legal Name (Verifiable with the Texas Secretary of State)

No Change**

**If “No Change” and Section I is complete, skip to Section III – Regulated Entity Information.

 

 

 

 

 

 

 

 

 

8. Type of Customer:

Corporation

 

Individual

Sole Proprietorship- D.B.A

 

City Government

County Government

 

Federal Government

State Government

 

Other Government

General Partnership

 

Limited Partnership

Other:

 

 

 

 

 

 

 

 

 

 

 

 

 

If new Customer, enter previous Customer

 

 

 

 

 

9. Customer Legal Name (If an individual, print last name first: ex: Doe, John)

 

 

 

End Date:

 

 

 

 

below

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10.Mailing

Address:

 

 

 

City

 

 

 

 

 

State

 

 

ZIP

 

 

ZIP + 4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11.

Country Mailing Information (if outside USA)

 

 

 

 

12. E-Mail Address (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13. Telephone Number

 

 

 

 

14. Extension or Code

 

 

15. Fax Number (if applicable)

 

 

(

)

-

 

 

 

 

 

 

 

 

 

 

(

 

 

)

-

 

 

 

16.

Federal Tax ID (9 digits)

 

17. TX State Franchise Tax ID (11 digits)

 

18. DUNS Number(if applicable)

 

 

19. TX SOS Filing Number (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20. Number of Employees

 

 

 

 

 

 

 

 

 

 

 

 

 

21. Independently Owned and Operated?

 

 

 

0-20

21-100

101-250

251-500

 

501 and higher

 

 

 

 

 

 

 

Yes

No

SECTION III: Regulated Entity Information

22. 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

No Change** (See below)

**If “NO CHANGE” is checked and Section I is complete, skip to Section IV, Preparer Information.

23. Regulated Entity Name (name of the site where the regulated action is taking place)

TCEQ-10400 (09/07)

Page 1 of 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

24.

Street Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

of the Regulated

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Entity:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(No P.O. Boxes)

 

 

City

 

 

 

 

State

 

 

 

ZIP

 

 

 

 

ZIP + 4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

25.

Mailing

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

State

 

 

 

ZIP

 

 

 

 

ZIP + 4

 

 

 

26.

E-Mail Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

27. Telephone Number

 

 

 

28. Extension or Code

 

 

29. Fax Number (if applicable)

 

(

)

-

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

-

 

 

 

 

 

 

30.

Primary SIC Code (4 digits)

 

 

31. Secondary SIC Code (4 digits)

 

 

32. Primary NAICS Code

 

 

33. Secondary NAICS Code

 

 

 

 

 

 

 

 

 

 

(5 or 6 digits)

 

 

 

 

 

 

(5 or 6 digits)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

34.

What is the Primary Business of this entity? (Please do not repeat the SIC or NAICS description.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Questions 34 – 37 address geographic location. Please refer to the instructions for applicability.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

35.Description to Physical Location:

 

36.

Nearest City

 

 

 

 

County

 

 

State

Nearest ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

37.

Latitude (N)

In Decimal:

 

 

 

 

38. Longitude (W)

In Decimal:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Degrees

 

Minutes

 

Seconds

 

Degrees

 

Minutes

 

Seconds

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

39.TCEQ Programs and ID Numbers Check all Programs and write in the permits/registration numbers that will be affected by the updates submitted on this form or the updates may not be made. If your Program is not listed, check other and write it in. See the Core Data Form instructions for additional guidance.

 

 

 

Dam Safety

 

 

Districts

 

 

 

Edwards Aquifer

 

 

 

Industrial Hazardous Waste

Municipal Solid Waste

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

New Source Review – Air

 

 

OSSF

 

 

 

Petroleum Storage Tank

PWS

Sludge

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Stormwater

 

 

Title V – Air

 

 

 

 

Tires

 

 

 

Used Oil

Utilities

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Voluntary Cleanup

 

 

Waste Water

 

 

 

 

Wastewater Agriculture

Water Rights

Other:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION IV: Preparer Information

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

40.

Name:

 

 

 

 

 

 

 

 

 

 

 

41. Title:

 

 

 

 

 

42.

Telephone Number

 

 

43. Ext./Code

 

 

44. Fax Number

 

 

45. E-Mail Address

 

 

(

)

 

-

 

 

 

 

(

)

-

 

 

 

 

 

 

 

SECTION V: Authorized Signature

46.By my signature below, I certify, to the best of my knowledge, that the information provided in this form is true and complete, and that I have signature authority to submit this form on behalf of the entity specified in Section II, Field 9 and/or as required for the updates to the ID numbers identified in field 39.

(See the Core Data Form instructions for more information on who should sign this form .)

 

Company:

 

 

 

Job Title:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name(In Print) :

 

 

 

 

 

 

 

Phone:

 

(

)

-

 

 

Signature:

 

 

 

 

 

 

 

Date:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TCEQ-10400 (09/07)

Page 2 of 2

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