660084_Correspondence_20200129

PO Box 10009 Goldsboro, NC 27532 1 [phone]
Raleigh Regional Supervisor
1628 Mail Service Center
Raleigh, NC 27699-1628
Mrs. Jane Bernard,
Please find attached copies of the Animal Waste Management System Operator Designation
Form forl.L.M. Plantation Farms LLC (66-84), J.L.M. Perry Farms LLC (42-13), and J.L.M. Perry
Nursery Farms LLC (42-5).
If you have questions regarding the attachments, please do not hesitate to contact me at your
convenience.
Respectfully Submitted,
Tyler ate
Environmental Specialist
Maxwell Foods, LLC / Goldsboro Milling Company
[e-mail]
Office: 919-778-3130 ext:1572
Cell: 252-521-1510

Animal Waste Management System Operator Designation Form
WPCSOCC
NCAC 15A 8F .0201
I'aeilitylTarm Name: J. L. M. Plantation Farms LLC
Permit Al Facility ID# b6-84-84 County: Noith Hampton
Operator In Charge (OIC)
Name: Christ opher Wade Williams —
First Middle Last Jr, Sr, etc.
Cert Type / Number: AWA 1002858 Phone: [phone]
00, sh .
Signature: p Date;
"T certify that I agree to my designation as the Operator in Charge for the facility noted. I understand and will abide by the rules and regulations
pertaining to the responsibilities set forth in 15A NCAC 08P .0203 and failing to do so can result in Disciplinary Actions by the Water
Pollution Control System Operators Certification Commission."
Bacic-up Operator In Charge (Bacic-up OIC) {Optional)
Name:
First Middle
Cert Type / Number:
Phone: ( )
Signature:
Last Jr, Sr, etc.
Date:
Work
"I certify that I agree to my designation as Back-up Operator in Charge for the facility noted. I understand and will abide by the rules and
regulations pertaining to the responsibilities sct forth In 15A NCAC 08F .0203 and failing to do so can result in Disciplinary Actions by the
Water Pollution Control System Operators Certification Commission,"
Owner/Permittee Name: J.-L.-M. Plantation Farms LLC _
Fax#:
Date: 1 79 Zo Zo