Form Apd-Exp Expedited Permitting Request Page 2
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2Form APD-EXP Expedited Permitting Request
I.
Contact Information
Company or Other Legal Customer Name:
Customer Reference Number (CN):
Regulated Entity Number (RN):
Company Official or Technical Contact Name:
Phone Number:
Email:
II.
Project Information
Facility Type:
Permit Number:
Project Number:
III.
Economic Justification
The purpose of the application associated with
this request to expedite will benefit the
YES
NO
economy of this state or an area of this state.
IV.
Delinquent Fees and Penalties
Applications will not be expedited if any delinquent fees and/or penalties are owed to the TCEQ or the Office
of the Attorney General on behalf of the TCEQ. For more information regarding Delinquent Fees and
Penalties, go to the TCEQ Web site at:
V.
Signature
The signature below confirms that I have knowledge of the facts included in this application and that these
facts are true and correct to the best of my knowledge and belief. As the applicant, I commit to fulfilling all
expectations of the expedited permitting program and application requirements promptly. Failure to meet any
expectation or requirement may cause my application to be removed from the expedited permitting program
and possibly voided at the discretion of the TCEQ Executive Director. The signature further signifies
awareness that intentionally or knowingly making or causing to be made false material statements or
representations in the application is a criminal offense subject to criminal penalties.
Name:
Signature:
Date:
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TCEQ 20706 (APDG 6257v1, Revised 11/14) Form APD-EXP
This form for use by facilities subject to air quality permits requirements and
may be revised periodically.
Page 2 of 2
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