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Home My WebLink AboutNC0088919_Signatory Authority_20111122 November 22, 2011 Point Source Branch Surface Water Protection Section Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 Subject: Delegation of Signature Authority Coliseum Shell NPDES No. NC 88919_ To Whom It May Concern: By notice of this letter,I hereby delegate signatory authority to each of the following individuals for all permit applications, discharge monitoring reports,and other information relating to the operations at Coliseum Shell as required by all applicable federal, state, and local environmental agencies specifically with the requirements for signatory authority as specified in 15A NCAC 2B.0506. i Name Title Ryan Kerins Operator in Responsible Charge Andy Wrenn Backup ORC Megan Webster Support Staff If you have any questions regarding this letter, please feel free to contact me at 919-563- 9091. Sincerely, fy �i-14.c Ernie Rhymer Senior Vice President cc: Winston-Salem Regional Office, Surface Water Protection Section Technical Assistance and Certification Unit DWR ,,,„ _4 _4, Division of Water Resources North Carolina(NC) eDMR Reports eDMR Registration Form EDMR is an electronic reporting system,which will provide a facility Owner the ability to submit discharge monitoring reports via the internet. EDMR is only currently available to facilities that have an NPDES Wastewater permit issued by the Division of Water Resources. Registration for eDMR must be completed by the legal Owner of the facility(s), and this legal Owner must be the same Owner to which the permit(s)have been issued. Once an Owner is registered for eDMR, all permits held by the Owner will also be registered and able to submit reports via eDMR. NOTE: Before completing and submitting the registration form, the legal Owners as specified above should verW'the permit facility, Owner, and DRC designations for all permits. This information can be verified using the eDMR Owner Information Search provided on the eDMR website. This information is maintained in the DWR data management system, as provided by the permittee, and contained in the permit issued to the Owner. Should any discrepancies with this information be determined, the appropriate DWR contact should be notified so information can be corrected prior to registration. It is important that the permit information be correct prior to eDMR registration. Please provide all information in Parts A,B, C and D. An Owner signature is required for eDMR registration. Should the registration information be incomplete,the registration process may be delayed. Part A: Owner Registration—Permit/Facility Information Please provide a Permit Number and the associated facility information. Only a single permit number is needed for registration. If multiple permits are involved, the permit number provided will be used to identify the Owner and all associated permits. All associated permits issued to the Owner will be registered for eDMR. Permit Number: NIC 10 1018 8 919 Facility Owner. Quality Oil Company Facility Name: Former Coliseum Shell Facility Address: 3009 University Parkway Facility City: Winston-Salem FacilityState NC Facility Zip code: 27105- NC eDMR Registration Form(Revision 3.1) Page 1 of 4 • Part B: Owner Registration-Owner User Details: Please provide the following information which is needed for creating the Facility Owner in eDMR. The Owner is the legal entity to which the permits)have been issued and may be an organization or individual. For an organization, the information provided for the owner details should be the official contact person or the person with delegated signatory authority for the Owner. Last Name Kerins Middle Name: Daniel lopF;n S� First Name:: Ryan bane- 'N�, a,' 5T:° Phone Number 919-563-901 • Email rdkerins@terraquestpc.com User 1(d (Assigned by DWR eDMR Administratm) Part C: User Account Information—Submitters Please provide the users,in addition to the Owner,who will need Submitter permissions. Submitter permissions can only be assigned by the DWR eDMR Administrator. The Owner specified above will be given full eDMR permissions including Submitter permissions. The Submitter is equivalent to the individual who signs the certification statement on the back of the discharge monitoring report. In most cases,the Submitter will be the Owner but may be other delegated individuals. The Submitter must be an individual with delegated signatory authority. If individuals other than the duly authorized person for the Owner have been delegated signatory authority,the Division of Water Resources must be notified in writing of such delegations. A delegation of authority form is available from the eDMR website. In addition to the User Details,please specify the permit(s)that each user will be associated with for eDMR submittal.Should additional space be needed for users and/or permits,please make additional copies of the Submitter User Details page and complete as needed. NOTE: The Owner will be responsible for creating all facility users except those with Submitter permissions. In addition to the Owner and Submitter user, there are four additional user types identified by user permission level: Facility Administrator, Certifier,Data Entry and View Only. The Owner and Facility Administrator will have the ability to manage facility users. The Facility User Administration Guide will provide the appropriate procedures for facility user management NC eDMR Registration Form(Revision 3.1) Page 2 of 4 Part D: Registration Certification: I request the facility identified above be allowed to submit DMR data using the NC DWR eDMR system. I understand that electronic submittal of the DMR does notfully satisfy US EPA's electronic signature requirements and as a result, I understand I be required to print, sign, and submit hardcopies(one signed original and a copy)of the eDMR to NC DWR under the same reporting requirements as paper-based DMRs as specified in Part II, Condition D(2)of the NPDES Permit. I agree to protect the security of my user ID and password from compromise and shall take all necessary steps to prevent its loss, disclosure, modification, or unauthorized use. Quality Oil Company Owner(Permittee)Name(type or print) Ryan Kerins, ORC,Project Manager-Terraquest Environmental Consultants,P.C. Official Title(type or Print) Akx-r-Reogtw(/ CEP ke-SEA/ -- U E S�'�Or[►^^' K4(!(A.Ya ui... of S��Q" rtito Lr47 ' December 31,2014 Owner rmittee) %nature Date A'crb c4.L D gizit.E.S4�t-PxtiV F Please return the completed Registration Form to the NC Division of Water Resources Fax: or Email: or Mail to: (919)807-6498 eDMRadmin rr ncdenr.sov Information Processing Unit Attn: eDMR Registration 1617 Mail Service Center Raleigh,NC 27699-1617 NC eDMR Registration Form(Revision 3.1) Page 4 of 4 Submitter:User Details:: Permit;No.(a) ` NC0088919 NCO() NCOO NCOO NCO() >First, lane Andy ?Mid lle`Name Wrenn 'hone Numbers 919-563-9091 'Email acwrennQ,terraquestpc.com User I1, (Assigned by DWR eDMR Administrator) Submitter User:Details NCOO NCOO NCOO NCO() NCOO 'First Name; M q a.1 Middle Na e' Y�asl Name; W5{C t' ge mler °)11-563-9o91 ?y ,�Wt S `(C rt 0.o`uL�-pt•co User 1D. (Assigned by DWR eDMR Administrator) F?emit No.(s�•. _' NCO() NCOO NCOO NCO(' NCOO ggARsORPMR:T' arne, - - iiMalfl'eNithe;40 Pit olne Number _ �r [Tsar ID (Assigned by DWR eDMR Administrator) Submitter.User Details NCO0 NCOO NCOO NCOO sFtName': iiwfdithivtioop,g_ ti ma 1,\ User ip (Assigned by DWR eDMR Administrator) NC eDMR Registration Pam(Revision 3.1) Page 3 of 4