NC0003468_ORC Designation Form_20210414

(n DUKE
ENERGY,
April 14, 2021
Winston Salem Regional Office
NCDEQ DWR
45 W. Hanes Mill Rd
Winston-Salem, NC 27105
Subject: Duke Energy Carolinas, LLC
Dan River Combined Cycle Station- NPDES Permit # NC0003468
Water Pollution Control Systems Designation (ORC) Form
Dan River Combined Cycle Station
864 S Edgewood Rd
Eden, !VC 27288
Attached is the completed revised operator designation form for Dan River Combined Cycle Station.
Please note that Gary Carroll, PC Certificate #: 1005561, will become the ORC for the site on May 1,
2021 and Dana Newcomb will be added as an additional back-up.
Should you have any questions regarding this form, please contact Billy Milam at 336-635-3023 or email
[e-mail].
Sincerely,
Terry W.Tuck
General Manager II- Dan River Combined Cycle/ Rockingham CT
cc: email to: certadminncdenr. ov on 3/1/2021

WATER POLLUTION CONTROL SYSTEM OPERATOR DESIGNATION FORM (WPCSOCC)
NCAC 15A 8G .0201
Press TAB to enter information
Permittee Owner/Officer Name: Terry Tuck
Mailing Address: 864 S. Edgewood RD
City: Eden
Email Address: [e-mail]
State: NC
Signature: _ P. JAII_�
k
Facility Name: Duke nergy Dan River CC Per it #
County: Rocki gham
_ Phone: [phone]
Zip: 27288
Date:
NC0003468
YOU MUST SUBMIT A SEPARATE FORM FOR EACH TYPE AND CLASSIFICATION OF SYSTEM:
Facility Type: PC
Facility Grade: I
OPERATOR IN RESPONSIBLE CHARGE (ORC)
Print Full Name: Gary Carroll Work Phone: [phone]
Certificate Type: PC
Certificate Grade:
Email Address: [e-mail]
Certificate M 1005561
Signature: Effective Date:
"1 certify that 1 agree to my detignation as the Operator in Responsible Charge for the facility noted. 1 understand and will abide by the
rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Print Full Name: William Milam
Certificate Type: PC
BACKUP ORC
Work Phone: [phone]
Certificate Grade: I
Certificate #: 28546
Email Address: [e-mail]
Signature: 1`' Effective Datoa
"l certify that l agree to my designation as a Back-up Orator in Responsible Charge for the facility noted. i understand and will abide by
the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Mail, fax or email WPCSOCC, 1618 Mail Service Center, Fax: [phone] Email: [e-mail]
ORIGINAL to: Raleigh, NC 27699-1618
Mail or Fax Asheville
a COPY to: 2090 US Hwy 70
5wannanoa, NC 28778
Fax: [phone]
Phone: [phone]
Washington
943 Washington Sq. Mail
Washington, NC 27889
Fax: [phone]
Phone: [phone]
Fayetteville
225 Green St., Suite 714
Fayetteville, NC 28301-5043
Fax: [phone]
Phone: [phone]
Wilmington
127 Cardinal Dr.
Wilmington, NC 28405-2845
Fax: [phone]
Phone: [phone]
Mooresville
Raleigh
610 E. Center Ave., Suite 301
3800 Barrett Dr.
Mooresville, NC 28115
Raleigh, NC 27609
Fax.[phone]
Fax:[phone]
Phone:[phone]
Phone:[phone]
Winston-Salem
45 W. Hanes Mail Rd.
Winston-Salem, NC 27105
Fax: [phone]
Phone: [phone] Revised 412016

WPCSOCC Operator Designation Form (continued)
Facility Name: Duke Energy Dan River CC
Permit #: NCO003468
Page 2
BACKUP ORC
Print Full Name: Dana Newcomb Work Phone: [phone]
Certificate Type: PC Certificate Grade: I Certificate #: 989611
Email Address: [e-mail]
Signature: ,�rrl _ Effective Date: '
"I certify that l agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. 1 underst nd and will abide by
the rules and regulations pertaining to the responsibilities of the ORC asset forth in 15A NCAC 08G .0204 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
BACKUP ORC
Print Full Name: David Brooks Work Phone: [phone]
Certificate Type: PC Certificate Grade: i Certificate M 991999
Email Address: David. brooks@duke-energy,corn
Signature: Effective Date: /
/,—
"I certify that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. i understand and will abide by
the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
BACKUP ORC
Print Full Name: Work Phone:
Certificate Type: Select Certificate Grade: Select Certificate #:
Email Address:
Signature: Effective Date:
"l certify that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. 1 understand and will abide by
the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission. "
BACKUP ORC
Print Full Name: Work Phone:
Certificate Type: Select Certificate Grade: Select Certificate M.
Email Address:
Signature: Effective Date:
"I certify that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. l understand and will abide by
the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Rewsed 412016