TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For PUBLIC UTILITY

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.01 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C5 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor PUBLIC UTILITY

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: 194 BUSH ACCOUNT: 20911

2015

2015

2015

20911

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*787287134382*

194 BUSH14050 SUMMIT DR STE 113AUSTIN, TX 78728-7134 0000020911 1533242 00000000000130169

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE

ZIP CODE

PHONE

NO.

RETURN ORIGINAL FORM TO COMMISSION RETAIN COPY FOR YOUR FILES

TCEQ VIPP Form WC04C (Rev. 08-16-02)

TEXAS COMMISSION ONENVIRONMENTAL QUALITYPO BOX 13089AUSTIN TX 78711-3089

*787113089899*

TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For PUBLIC UTILITY

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.01 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C5 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor PUBLIC UTILITY

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: 3009 WATER ACCOUNT: 13070

2015

2015

2015

13070

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*772656799994*

3009 WATERPO BOX 6799HOUSTON, TX 77265-6799 0000013070 1533242 00000000000130161

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE

ZIP CODE

PHONE

NO.

RETURN ORIGINAL FORM TO COMMISSION RETAIN COPY FOR YOUR FILES

TCEQ VIPP Form WC04C (Rev. 08-16-02)

TEXAS COMMISSION ONENVIRONMENTAL QUALITYPO BOX 13089AUSTIN TX 78711-3089

*787113089899*

TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For DISTRICT or For WATER SUPPLY/SEWER SERVICE CORPORATIONS

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.005 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C4 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor DISTRICT or For WATER SUPPLY/SEWER SERVICE CORPORATION

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: 3G WSC ACCOUNT: 11565

2015

2015

2015

11565

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*786094308041*

3G WSC504 WILLOW STBUCHANAN DAM, TX 78609-4308 0000011565 1533242 00000000000130167

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE

ZIP CODE

PHONE

NO.

RETURN ORIGINAL FORM TO COMMISSION RETAIN COPY FOR YOUR FILES

TCEQ VIPP Form WC04C (Rev. 08-16-02)

TEXAS COMMISSION ONENVIRONMENTAL QUALITYPO BOX 13089AUSTIN TX 78711-3089

*787113089899*

TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For PUBLIC UTILITY

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.01 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C5 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor PUBLIC UTILITY

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: 4-D WATER ACCOUNT: 11767

2015

2015

2015

11767

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*76904*

4-D WATER5905 CALLISON RDSAN ANGELO, TX 76904-0000 0000011767 1533242 00000000000130163

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE

ZIP CODE

PHONE

NO.

RETURN ORIGINAL FORM TO COMMISSION RETAIN COPY FOR YOUR FILES

TCEQ VIPP Form WC04C (Rev. 08-16-02)

TEXAS COMMISSION ONENVIRONMENTAL QUALITYPO BOX 13089AUSTIN TX 78711-3089

*787113089899*

TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For DISTRICT or For WATER SUPPLY/SEWER SERVICE CORPORATIONS

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.005 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C4 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor DISTRICT or For WATER SUPPLY/SEWER SERVICE CORPORATION

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: 410 WSC ACCOUNT: 10511

2015

2015

2015

10511

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*754360069695*

410 WSCPO BOX 69DETROIT, TX 75436-0069 0000010511 1533242 00000000000130164

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE

ZIP CODE

PHONE

NO.

RETURN ORIGINAL FORM TO COMMISSION RETAIN COPY FOR YOUR FILES

TCEQ VIPP Form WC04C (Rev. 08-16-02)

TEXAS COMMISSION ONENVIRONMENTAL QUALITYPO BOX 13089AUSTIN TX 78711-3089

*787113089899*

TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For DISTRICT or For WATER SUPPLY/SEWER SERVICE CORPORATIONS

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.005 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C4 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor DISTRICT or For WATER SUPPLY/SEWER SERVICE CORPORATION

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: 439 WSC ACCOUNT: 10001

2015

2015

2015

10001

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*765134880026*

439 WSC6202 SPARTA RDBELTON, TX 76513-4880 0000010001 1533242 00000000000130161

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE

ZIP CODE

PHONE

NO.

RETURN ORIGINAL FORM TO COMMISSION RETAIN COPY FOR YOUR FILES

TCEQ VIPP Form WC04C (Rev. 08-16-02)

TEXAS COMMISSION ONENVIRONMENTAL QUALITYPO BOX 13089AUSTIN TX 78711-3089

*787113089899*

TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For PUBLIC UTILITY

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.01 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C5 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor PUBLIC UTILITY

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: 723 UTILITY ACCOUNT: 13039

2015

2015

2015

13039

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*774067682995*

723 UTILITY5545 FM 359RICHMOND, TX 77406-7682 0000013039 1533242 00000000000130161

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE

ZIP CODE

PHONE

NO.

RETURN ORIGINAL FORM TO COMMISSION RETAIN COPY FOR YOUR FILES

TCEQ VIPP Form WC04C (Rev. 08-16-02)

TEXAS COMMISSION ONENVIRONMENTAL QUALITYPO BOX 13089AUSTIN TX 78711-3089

*787113089899*

TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For DISTRICT or For WATER SUPPLY/SEWER SERVICE CORPORATIONS

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.005 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C4 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor DISTRICT or For WATER SUPPLY/SEWER SERVICE CORPORATION

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: 84 WEST WSC ACCOUNT: 10786

2015

2015

2015

10786

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*766670304047*

84 WEST WSCPO BOX 304MEXIA, TX 76667-0304 0000010786 1533242 00000000000130162

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE

ZIP CODE

PHONE

NO.

RETURN ORIGINAL FORM TO COMMISSION RETAIN COPY FOR YOUR FILES

TCEQ VIPP Form WC04C (Rev. 08-16-02)

TEXAS COMMISSION ONENVIRONMENTAL QUALITYPO BOX 13089AUSTIN TX 78711-3089

*787113089899*

TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For DISTRICT or For WATER SUPPLY/SEWER SERVICE CORPORATIONS

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.005 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C4 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor DISTRICT or For WATER SUPPLY/SEWER SERVICE CORPORATION

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: A & P WSC ACCOUNT: 11180

2015

2015

2015

11180

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*756330322225*

A & P WSCPO BOX 322CARTHAGE, TX 75633-0322 0000011180 1533242 00000000000130162

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE

ZIP CODE

PHONE

NO.

RETURN ORIGINAL FORM TO COMMISSION RETAIN COPY FOR YOUR FILES

TCEQ VIPP Form WC04C (Rev. 08-16-02)

TEXAS COMMISSION ONENVIRONMENTAL QUALITYPO BOX 13089AUSTIN TX 78711-3089

*787113089899*

TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For DISTRICT or For WATER SUPPLY/SEWER SERVICE CORPORATIONS

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.005 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C4 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor DISTRICT or For WATER SUPPLY/SEWER SERVICE CORPORATION

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: ABLES SPRINGS WSC ACCOUNT: 10819

2015

2015

2015

10819

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*751600028678*

ABLES SPRINGS WSCP.O. BOX 1567TERRELL, TX 75160-0028 0000010819 1533242 00000000000130163

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE

ZIP CODE

PHONE

NO.

RETURN ORIGINAL FORM TO COMMISSION RETAIN COPY FOR YOUR FILES

TCEQ VIPP Form WC04C (Rev. 08-16-02)

TEXAS COMMISSION ONENVIRONMENTAL QUALITYPO BOX 13089AUSTIN TX 78711-3089

*787113089899*

TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For PUBLIC UTILITY

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.01 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C5 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor PUBLIC UTILITY

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: ABRAXAS ACCOUNT: 11596

2015

2015

2015

11596

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*761824035211*

ABRAXAS7921 MAIN STFORT WORTH, TX 76182-4035 0000011596 1533242 00000000000130160

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE

ZIP CODE

PHONE

NO.

RETURN ORIGINAL FORM TO COMMISSION RETAIN COPY FOR YOUR FILES

TCEQ VIPP Form WC04C (Rev. 08-16-02)

TEXAS COMMISSION ONENVIRONMENTAL QUALITYPO BOX 13089AUSTIN TX 78711-3089

*787113089899*

TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For DISTRICT or For WATER SUPPLY/SEWER SERVICE CORPORATIONS

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.005 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C4 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor DISTRICT or For WATER SUPPLY/SEWER SERVICE CORPORATION

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: ACTON MUD ACCOUNT: 12971

2015

2015

2015

12971

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*760492035202*

ACTON MUD6420 LUSK BRANCH CTGRANBURY, TX 76049-2035 0000012971 1533242 00000000000130163

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE

ZIP CODE

PHONE

NO.

RETURN ORIGINAL FORM TO COMMISSION RETAIN COPY FOR YOUR FILES

TCEQ VIPP Form WC04C (Rev. 08-16-02)

TEXAS COMMISSION ONENVIRONMENTAL QUALITYPO BOX 13089AUSTIN TX 78711-3089

*787113089899*

TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For DISTRICT or For WATER SUPPLY/SEWER SERVICE CORPORATIONS

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.005 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C4 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor DISTRICT or For WATER SUPPLY/SEWER SERVICE CORPORATION

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: ADDICKS UTILITY DISTRICT ACCOUNT: P0054

2015

2015

2015

P0054

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*770029552003*

ADDICKS UTILITY DISTRICT3401 LOUISIANA ST STE 400HOUSTON, TX 77002-9552 0000060054 1533242 00000000000130162

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE

ZIP CODE

PHONE

NO.

RETURN ORIGINAL FORM TO COMMISSION RETAIN COPY FOR YOUR FILES

TCEQ VIPP Form WC04C (Rev. 08-16-02)

TEXAS COMMISSION ONENVIRONMENTAL QUALITYPO BOX 13089AUSTIN TX 78711-3089

*787113089899*

TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For PUBLIC UTILITY

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.01 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C5 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor PUBLIC UTILITY

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: AERO VALLEY WATER SERVICE ACCOUNT: 11401

2015

2015

2015

11401

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*762623612816*

AERO VALLEY WATER SERVICE5281 KELLY DRROANOKE, TX 76262-3612 0000011401 1533242 00000000000130165

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE

ZIP CODE

PHONE

NO.

RETURN ORIGINAL FORM TO COMMISSION RETAIN COPY FOR YOUR FILES

TCEQ VIPP Form WC04C (Rev. 08-16-02)

TEXAS COMMISSION ONENVIRONMENTAL QUALITYPO BOX 13089AUSTIN TX 78711-3089

*787113089899*

TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For DISTRICT or For WATER SUPPLY/SEWER SERVICE CORPORATIONS

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.005 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C4 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor DISTRICT or For WATER SUPPLY/SEWER SERVICE CORPORATION

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: AFTON GROVE WSC ACCOUNT: 12372

2015

2015

2015

12372

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*757661282826*

AFTON GROVE WSCPO BOX 1282JACKSONVILLE, TX 75766-1282 0000012372 1533242 00000000000130168

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE

ZIP CODE

PHONE

NO.

RETURN ORIGINAL FORM TO COMMISSION RETAIN COPY FOR YOUR FILES

TCEQ VIPP Form WC04C (Rev. 08-16-02)

TEXAS COMMISSION ONENVIRONMENTAL QUALITYPO BOX 13089AUSTIN TX 78711-3089

*787113089899*

TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For DISTRICT or For WATER SUPPLY/SEWER SERVICE CORPORATIONS

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.005 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C4 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor DISTRICT or For WATER SUPPLY/SEWER SERVICE CORPORATION

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: AGUA SUD ACCOUNT: 10559

2015

2015

2015

10559

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*785730075792*

AGUA SUDPO BOX 4379MISSION, TX 78573-0075 0000010559 1533242 00000000000130167

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE

ZIP CODE

PHONE

NO.

RETURN ORIGINAL FORM TO COMMISSION RETAIN COPY FOR YOUR FILES

TCEQ VIPP Form WC04C (Rev. 08-16-02)

TEXAS COMMISSION ONENVIRONMENTAL QUALITYPO BOX 13089AUSTIN TX 78711-3089

*787113089899*

TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For PUBLIC UTILITY

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.01 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C5 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor PUBLIC UTILITY

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: AIM WATER ACCOUNT: 12526

2015

2015

2015

12526

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*793821058584*

AIM WATERPO BOX 1058WOLFFORTH, TX 79382-1058 0000012526 1533242 00000000000130163

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE

ZIP CODE

PHONE

NO.

RETURN ORIGINAL FORM TO COMMISSION RETAIN COPY FOR YOUR FILES

TCEQ VIPP Form WC04C (Rev. 08-16-02)

TEXAS COMMISSION ONENVIRONMENTAL QUALITYPO BOX 13089AUSTIN TX 78711-3089

*787113089899*

TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For PUBLIC UTILITY

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.01 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C5 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor PUBLIC UTILITY

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: AIR PARK HOA ACCOUNT: 12860

2015

2015

2015

12860

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*750936503002*

AIR PARK HOA6300 DOUGLAS STPLANO, TX 75093-6503 0000012860 1533242 00000000000130167

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE

ZIP CODE

PHONE

NO.

RETURN ORIGINAL FORM TO COMMISSION RETAIN COPY FOR YOUR FILES

TCEQ VIPP Form WC04C (Rev. 08-16-02)

TEXAS COMMISSION ONENVIRONMENTAL QUALITYPO BOX 13089AUSTIN TX 78711-3089

*787113089899*

TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For PUBLIC UTILITY

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.01 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C5 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor PUBLIC UTILITY

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: ALBURY MANOR UTILITY ACCOUNT: 11507

2015

2015

2015

11507

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*773888908318*

ALBURY MANOR UTILITY400 RANDAL WAY STE 106SPRING, TX 77388-8908 0000011507 1533242 00000000000130168

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE

ZIP CODE

PHONE

NO.

RETURN ORIGINAL FORM TO COMMISSION RETAIN COPY FOR YOUR FILES

TCEQ VIPP Form WC04C (Rev. 08-16-02)

TEXAS COMMISSION ONENVIRONMENTAL QUALITYPO BOX 13089AUSTIN TX 78711-3089

*787113089899*

TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For PUBLIC UTILITY

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.01 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C5 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor PUBLIC UTILITY

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: ALDINE ISD GRACE RAYMOND ELEMENTARY SCHOOL ACCOUNT: N0062

2015

2015

2015

N0062

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*770323028107*

ALDINE ISD GRACE RAYMOND ELEMENTA14910 ALDINE WESTFIELD RDHOUSTON, TX 77032-3028 0000040062 1533242 00000000000130164

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE

ZIP CODE

PHONE

NO.

RETURN ORIGINAL FORM TO COMMISSION RETAIN COPY FOR YOUR FILES

TCEQ VIPP Form WC04C (Rev. 08-16-02)

TEXAS COMMISSION ONENVIRONMENTAL QUALITYPO BOX 13089AUSTIN TX 78711-3089

*787113089899*

TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For PUBLIC UTILITY

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.01 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C5 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor PUBLIC UTILITY

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: ALEDO MHP ACCOUNT: N0031

2015

2015

2015

N0031

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*760084439739*

ALEDO MHP124 YATES CIR UNIT AALEDO, TX 76008-4439 0000040031 1533242 00000000000130162

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE

ZIP CODE

PHONE

NO.

RETURN ORIGINAL FORM TO COMMISSION RETAIN COPY FOR YOUR FILES

TCEQ VIPP Form WC04C (Rev. 08-16-02)

TEXAS COMMISSION ONENVIRONMENTAL QUALITYPO BOX 13089AUSTIN TX 78711-3089

*787113089899*

TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For PUBLIC UTILITY

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.01 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C5 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor PUBLIC UTILITY

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: ALGONQUIN WATER RESOURCES OF TEXAS ACCOUNT: 13131

2015

2015

2015

13131

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*853929524418*

ALGONQUIN WATER RESOURCES OF TEXA12725 W INDIAN SCHOOL RD STE D101AVONDALE, AZ 85392-9524 0000013131 1533242 00000000000130168

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE

ZIP CODE

PHONE

NO.

RETURN ORIGINAL FORM TO COMMISSION RETAIN COPY FOR YOUR FILES

TCEQ VIPP Form WC04C (Rev. 08-16-02)

TEXAS COMMISSION ONENVIRONMENTAL QUALITYPO BOX 13089AUSTIN TX 78711-3089

*787113089899*

TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For PUBLIC UTILITY

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.01 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C5 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor PUBLIC UTILITY

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: ALMAGER WATER SYSTEM ACCOUNT: N0050

2015

2015

2015

N0050

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*797067077046*

ALMAGER WATER SYSTEM804 E COUNTY ROAD 133MIDLAND, TX 79706-7077 0000040050 1533242 00000000000130168

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE

ZIP CODE

PHONE

NO.

RETURN ORIGINAL FORM TO COMMISSION RETAIN COPY FOR YOUR FILES

TCEQ VIPP Form WC04C (Rev. 08-16-02)

TEXAS COMMISSION ONENVIRONMENTAL QUALITYPO BOX 13089AUSTIN TX 78711-3089

*787113089899*

TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For PUBLIC UTILITY

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.01 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C5 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor PUBLIC UTILITY

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: ALPHA UTILITY OF CAMP COUNTY ACCOUNT: 12696

2015

2015

2015

12696

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*756860818182*

ALPHA UTILITY OF CAMP COUNTYPO BOX 818PITTSBURG, TX 75686-0818 0000012696 1533242 00000000000130167

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE

ZIP CODE

PHONE

NO.

RETURN ORIGINAL FORM TO COMMISSION RETAIN COPY FOR YOUR FILES

TCEQ VIPP Form WC04C (Rev. 08-16-02)

TEXAS COMMISSION ONENVIRONMENTAL QUALITYPO BOX 13089AUSTIN TX 78711-3089

*787113089899*

TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For DISTRICT or For WATER SUPPLY/SEWER SERVICE CORPORATIONS

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.005 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C4 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor DISTRICT or For WATER SUPPLY/SEWER SERVICE CORPORATION

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: ALTO RURAL WSC ACCOUNT: 10783

2015

2015

2015

10783

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*759250616162*

ALTO RURAL WSCPO BOX 616ALTO, TX 75925-0616 0000010783 1533242 00000000000130165

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE

ZIP CODE

PHONE

NO.

RETURN ORIGINAL FORM TO COMMISSION RETAIN COPY FOR YOUR FILES

TCEQ VIPP Form WC04C (Rev. 08-16-02)

TEXAS COMMISSION ONENVIRONMENTAL QUALITYPO BOX 13089AUSTIN TX 78711-3089

*787113089899*

TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For DISTRICT or For WATER SUPPLY/SEWER SERVICE CORPORATIONS

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.005 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C4 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor DISTRICT or For WATER SUPPLY/SEWER SERVICE CORPORATION

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: ALTOGA WSC ACCOUNT: 12580

2015

2015

2015

12580

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*754072473650*

ALTOGA WSC4365 FM 75PRINCETON, TX 75407-2473 0000012580 1533242 00000000000130166

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE

ZIP CODE

PHONE

NO.

RETURN ORIGINAL FORM TO COMMISSION RETAIN COPY FOR YOUR FILES

TCEQ VIPP Form WC04C (Rev. 08-16-02)

TEXAS COMMISSION ONENVIRONMENTAL QUALITYPO BOX 13089AUSTIN TX 78711-3089

*787113089899*

TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For PUBLIC UTILITY

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.01 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C5 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor PUBLIC UTILITY

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: AMBERWOOD UTILITY ACCOUNT: 12163

2015

2015

2015

12163

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*773385214000*

AMBERWOOD UTILITY1900 1ST ST EHUMBLE, TX 77338-5214 0000012163 1533242 00000000000130161

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE

ZIP CODE

PHONE

NO.

RETURN ORIGINAL FORM TO COMMISSION RETAIN COPY FOR YOUR FILES

TCEQ VIPP Form WC04C (Rev. 08-16-02)

TEXAS COMMISSION ONENVIRONMENTAL QUALITYPO BOX 13089AUSTIN TX 78711-3089

*787113089899*

TEXAS COMMISSION ON ENVIRONMENTAL QUALITYRevenue and Regulatory Assessment Report

For PUBLIC UTILITY

Revenue and Regulatory Assessment Report for the Calendar Year

1. Enter total revenues from retail water and sewer service in year 1.

2. Enter amount collected OR multiply item 1 by 0.01 2.

3. Late payment penalty: 3.

5% - If paid after January 30th and before March 1st - multiply line 2 by 0.0510% - If paid after March 1st - multiply line 2 by 0.10

4. Late payment interest, 1% per month if paid after March 31st: 4.a. Multiply line 2 by 0.01 = monthly interest due, thenb. Multiply monthly interest due by the number of months payment is made afterMarch 31, rounded to the nearest month.

5. Amount due and payable (Add lines 2, 3, and 4). 5.

Please note if the utility was inactive for more than a month during the year or experienced other circumstanceswhich affected revenues (attach an additional page if necessary):

I declare that the above information is true and correct to the best of my knowledge and belief.

Signature Date / /

Preparers name Phone number (Please Print)

VIPP Form WC04C5 / TCEQ-20098

Calendar Year

REVENUE & REGULATORY ASSESSMENT REPORTFor PUBLIC UTILITY

PLEASE RETURN ENTIRE ORIGINAL FORMWITH CHECK OR MONEY ORDER PAYABLE TO:

TEXAS COMMISSION ONENVIRONMENTAL QUALITY

AMOUNT ENCLOSED ACCOUNT NO.

CHECK HERE IF YOUR ADDRESS OR YOUR PHONE NUMBERHAVE CHANGED. PLEASE INDICATE ADDRESS OR PHONENUMBER CHANGE ON BACK.

UTILITY: AMC CREEKSIDE ACCOUNT: 12032

2015

2015

2015

12032

PAYMENTS NOT RECEIVED BY JANUARY 30,WILL RECEIVE A NOTICE OF VIOLATION

*750678016992*

AMC CREEKSIDE4000 ACE LNLEWISVILLE, TX 75067-8016 0000012032 1533242 00000000000130160

PAYMENT INFORMATION

Please return ENTIRE ORIGINAL FORM with your payment in the enclosed envelope.

Your check, certified check, or money order should be made payable to Texas Commission on EnvironmentalQuality. Please include your account number on your check to ensure that payment is properly credited.

If you have questions regarding the regulatory assessment or desire assistance in completing the Revenue &Regulatory Assessment Report, please contact our Regulatory Assessment Coordinator at 512/239-4691.

When submitting assessment payments to the Commission, please note the following:

1. The regulatory assessment applies to charges for water and sewer service only. The fee should not beassessed against surcharges, tap fees, reconnect fees, late fees, or return check charges.

2. Address changes should be submitted on this form, or in writing during the year as changes occur.

3. REPORT EACH UTILITY ON SEPARATE REPORT APPLICABLE TO THAT UTILITY.

ADDRESS

CITY

STATE