The TCEQ Core Data Form serves as a critical instrument in the structured and meticulous approach to environmental regulation and compliance within Texas. Primarily utilized by the Texas Commission on Environmental Quality (TCEQ), this form is essential for businesses and individuals preparing to submit applications for new permits, registrations, or authorizations, as well as for those seeking renewals or reporting changes in ownership or legal names. Additionally, it plays a vital role in updating customer information and regulated entity details, ensuring that the TCEQ has accurate and current data to facilitate effective oversight. The form is designed to collect comprehensive information, including customer legal names, contact details, types of entities (ranging from corporations to government entities), employee numbers, and the nature of ownership. It also requests specifics about the regulated entity, such as its name, address, primary business activities as defined by Standard Industrial Classification (SIC) and North American Industry Classification System (NAICS) codes, and its involvement in various TCEQ programs. Completing this form correctly is not only obligatory for regulatory compliance but also pivotal in safeguarding environmental standards. With instructions provided for ease of completion, this document underlines the intricate relationship between regulatory endeavors and the assurance of environmental integrity. For those navigating the regulatory landscape of Texas's environmental sector, understanding and accurately filling out the TCEQ Core Data Form is an indispensable step.
Question | Answer |
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Form Name | Tceq Core Data Form |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names | environmental tceq core data form, tceq core data form pdf, tceq core line online, tceq core data form |
TCEQ Core Data Form
TCEQ Use Only
For detailed instructions regarding completion of this form, please read the Core Data Form Instructions or call
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.)
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Renewal (Core Data Form should be submitted with the renewal form) |
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Other |
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2. Customer Reference Number (if issued) |
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3. Regulated Entity Reference Number (if issued) |
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CN |
for CN or RN numbers in |
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RN |
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Central Registry** |
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SECTION II: Customer Information
4. General Customer Information
5. Effective Date for Customer Information Updates (mm/dd/yyyy)
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).
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6. Customer Legal Name (If an individual, print last name first: eg: Doe, John) |
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If new Customer, enter previous Customer below: |
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7. TX SOS/CPA Filing Number |
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8. TX State Tax ID (11 |
digits) |
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9. Federal Tax ID (9 digits) |
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10. DUNS Number (if applicable) |
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11 |
. Type of Customer: |
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Corporation |
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Individual |
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Partnership: |
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General |
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Limited |
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Government: |
City County |
Federal |
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State Other |
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Sole Proprietorship |
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Other: |
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12. |
Number of Employees |
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13. Independently Owned and Operated? |
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501 and higher |
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Yes |
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No |
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14. |
Customer Role (Proposed or Actual) – as it relates to the Regulated Entity listed on this form. Please check one of the following: |
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Owner |
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Operator |
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Owner & Operator |
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Occupational Licensee |
Responsible Party |
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Voluntary Cleanup Applicant |
Other: |
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15. Mailing |
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Address: |
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City |
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State |
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ZIP |
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ZIP + 4 |
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16. |
Country Mailing Information (if outside USA) |
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18. |
Telephone Number |
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19. Extension or Code |
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20. Fax Number (if applicable) |
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SECTION III: Regulated Entity Information
21.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.)
Page 1 of 2 |
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23. |
Street Address of |
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the Regulated Entity: |
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(No PO Boxes) |
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City |
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State |
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ZIP |
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ZIP + 4 |
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24. |
County |
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Enter Physical Location Description if no street address is provided. |
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25.Description to Physical Location:
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Nearest City |
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State |
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Nearest ZIP Code |
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27. |
Latitude (N) |
In Decimal: |
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28. Longitude (W) In Decimal: |
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Degrees |
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Minutes |
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Seconds |
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Degrees |
Minutes |
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Seconds |
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29. Primary SIC Code (4 digits) |
30. Secondary SIC Code (4 digits) |
31. Primary NAICS Code |
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32. Secondary NAICS Code |
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(5 or 6 digits) |
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33. |
What is the Primary Business of this entity? |
(Do not repeat the SIC or NAICS description.) |
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34.Mailing Address:
City
State
ZIP
ZIP + 4
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36. Telephone Number |
37. Extension or Code |
38. Fax Number (if applicable) |
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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. See the Core Data Form instructions for additional guidance.
Dam Safety |
Districts |
Edwards Aquifer |
Emissions Inventory Air |
Industrial Hazardous Waste |
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Municipal Solid Waste |
New Source Review Air |
OSSF |
Petroleum Storage Tank |
PWS |
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Sludge |
Storm Water |
Title V Air |
Tires |
Used Oil |
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Voluntary Cleanup |
Waste Water |
Wastewater Agriculture |
Water Rights |
Other: |
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SECTION IV: Preparer Information
40. |
Name: |
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41. Title: |
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42. |
Telephone Number |
43. Ext./Code |
44. Fax Number |
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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 6 and/or as required for the updates to the ID numbers identified in field 39.
Company:
Name(In Print) :
Signature:
Job Title:
Phone: |
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Date:
Page 2 of 2 |