Form Tceq-20207 - Dry Cleaning Drop Station Registration
Download a blank fillable Form Tceq-20207 - Dry Cleaning Drop Station Registration in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Tceq-20207 - Dry Cleaning Drop Station Registration with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2DCR /
/ CO /
/ DS
For internal use only
TCEQ - DRY CLEANING DROP STATION REGISTRATION FORM
TCEQ Account No. :
Please mail completed form to:
Texas
For Use
Dry Cleaning Registration Team (MC-138)
Commission
Texas Commission on Environmental Quality
Federal Tax ID No. :
In
on
P. O. Box 13087
Texas
Environmental
Austin, Texas 78711-3087
Taxpayer ID No. :
Quality
(512) 239-2160 and fax # (512) 239-3398
TCEQ rules (Title 30 TAC § 337) state that annual renewal registration forms are due by August 1st of each year
For each facility, complete a separate Dry Cleaning Facility Registration Form (Form# 20092)
)
Section 1. Reason For Filing the Form
(Check all that apply
1
Initial Registration 2
Renewal Registration 3
Ownership Change (indicate effective date) ____/_____/_____
4
No longer a drop station (Indicate effective date of the closing of the drop station)
_____/_____/_____
5
Change from facility to drop station (Indicate effective date of change)
____/_____/_____
6
Amendment of:
Owner Information 9
Drop Station Information
Real Property Owner
Other_______________
Section 2. Owner Information
Customer No.: CN ______________________
Owner Name: Business Name or Last Name _______________________________First Name________________________
Mailing Address:__________________________________City:___________________State:________Zip Code:_________
Billing Address (if different):_________________________City: __________________State:________ Zip Code:_________
Country (Outside USA) :__________________Email Address :__________________________________________________
Owner's Authorized Representative: ________________________Title: ______________Phone No: ______/_____-______
Type of Owner: :
Individual
Sole Proprietorship DBA
Corporation
Partnership
Other __________
Location of Records:
At facility
Offsite at: Address:___________________________City:_________________State:________
Records Custodian/Contact Person: _______________Phone No.:______/______-______Fax No : _____/______-______
State Franchise Tax ID: ____________________ DUNS No. :______________________
Independently Owned & Operated :
Yes
No # of Employees:
0-20
21-100
101-250
251-500
501 & Higher
**This form will not be processed until all delinquent fees and/or penalties owed to the TCEQ or the Office of the Attorney
General on behalf of the TCEQ are paid in accordance with the
Delinquent Fee and Penalty Protocol
.**
Have you ever used or allowed the use of the dry cleaning solvent perchloroethylene at a dry cleaning facility or drop
station in this state?
Yes
No
Has the dry cleaning solvent perchloroethylene ever been used at this location?
Yes
No
3. Drop Station Information
Regulated Entity No.: RN __________________
Drop Station Name: ____________________________ Street Address:___________________________________________
City: __________________TEXAS Zip Code: _________County: _________Contact Person:_________________________
Title:______________ Phone No.:_____/______-______ Email Address :__________________Fax No.:_____/_____-____
Primary SIC Code:________ Secondary SIC:________ Primary NAICS Code :_________ Secondary NAICS Code:________
Latitude: Degrees _______Minutes _______Seconds ________ Longitude: Degrees ________Minutes________ Seconds _________
Please indicate your gross receipts (this includes all sources of income from this location, including laundry receipts) for the
$150,000 or less
more than $150,000
last consecutive 12 months reported to the Comptroller:
This number should be the same as the ATotal Sales@ line on your Sales & Use Tax Return.
GROSS RECEIPTS WILL BE VERIFIED BY THE TEXAS COMPTROLLER OF PUBLIC ACCOUNTS
(If this information is not verified to be accurate, your dry cleaning registration certificate may be withheld)
Date operations began at this location_____/______/_______.
Yes or
No
Was this location ever a dry cleaning facility prior to the date you began operations?
Please complete a separate form for each dry cleaning drop station.
For each facility, complete a separate Dry Cleaning Facility Registration Form (Form# 20092)
TCEQ-20207(Rev 8/30/2006)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal