Tceq Core Data Form PDF Details

Are you working in an environment where data needs to be collected and constantly monitored? Do you need a reliable way of storing, tracking, and presenting this data in an organized manner? If yes, then the Tceq Core Data Form may be exactly what your business is looking for. This form can help strengthen your organization's reporting capabilities while simplifying data management processes at the same time. In this blog post, we will discuss how the Tceq Core Data Form can streamline your workflow and provide easily accessible insights into key performance indicators (KPIs) within any department or field of operations. Read on to learn more about why having access to core data forms like these provides such powerful value!

QuestionAnswer
Form NameTceq Core Data Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesenvironmental tceq core data form, tceq core data form pdf, tceq core line online, tceq core data form

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. Customer Reference Number (if issued)

Follow this link to search

 

3. Regulated Entity Reference Number (if issued)

 

 

 

 

 

CN

for CN or RN numbers in

 

RN

 

Central Registry**

 

 

 

 

 

 

 

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).

 

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

 

 

If new Customer, enter previous Customer below:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7. TX SOS/CPA Filing Number

 

 

8. TX State Tax ID (11

digits)

 

9. 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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13. Independently Owned and Operated?

 

 

 

 

0-20

 

21-100

 

 

101-250

251-500

 

 

501 and higher

 

 

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14.

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:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

State

 

 

 

ZIP

 

 

 

 

 

 

 

ZIP + 4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16.

Country Mailing Information (if outside USA)

 

 

 

 

 

 

17. E-Mail Address (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18.

Telephone Number

 

 

 

 

 

19. Extension or Code

 

 

 

20. Fax Number (if applicable)

 

(

 

)

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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.)

TCEQ-10400 (04/15)

Page 1 of 2

 

23.

Street Address of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

the Regulated Entity:

 

 

 

 

 

 

 

 

 

 

 

 

(No PO Boxes)

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

State

 

ZIP

 

ZIP + 4

 

 

 

 

 

 

 

 

 

 

 

 

 

24.

County

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Enter Physical Location Description if no street address is provided.

 

 

 

25.Description to Physical Location:

 

26.

Nearest City

 

 

 

 

 

 

 

 

 

State

 

 

 

 

Nearest ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

27.

Latitude (N)

In Decimal:

 

 

 

 

 

28. Longitude (W) In Decimal:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Degrees

 

Minutes

 

 

 

Seconds

 

Degrees

Minutes

 

 

Seconds

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

29. Primary SIC Code (4 digits)

30. Secondary SIC Code (4 digits)

31. Primary NAICS Code

 

32. Secondary NAICS Code

 

 

(5 or 6 digits)

 

(5 or 6 digits)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

33.

What is the Primary Business of this entity?

(Do not repeat the SIC or NAICS description.)

 

 

 

 

 

 

 

34.Mailing Address:

City

State

ZIP

ZIP + 4

35. E-Mail Address:

36. Telephone Number

37. Extension or Code

38. Fax Number (if applicable)

(

)

-

 

(

)

-

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

 

 

 

 

 

 

 

 

 

 

Municipal Solid Waste

New Source Review Air

OSSF

Petroleum Storage Tank

PWS

 

 

 

 

 

 

 

 

 

 

Sludge

Storm Water

Title V Air

Tires

Used Oil

 

 

 

 

 

 

 

 

 

 

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 6 and/or as required for the updates to the ID numbers identified in field 39.

Company:

Name(In Print) :

Signature:

Job Title:

Phone:

(

)

-

Date:

TCEQ-10400 (04/15)

Page 2 of 2

Tceq Core Data Form isn’t the one you’re looking for?

Related Documents