NC0006033_ORC Designation Form_20240826

WATER POLLUTION CONTROL SYSTEM OPERATOR DESIGNATION FORM
Facility Name:
NCAC 15A 8G .0201
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EAGLE ROAD WWTP
Permit # NC0006033
Facility Type: WW Facility Grade: IV SUBMIT SEPARATE FORM FOR EACH CLASSIFICATION
Permittee Owner/Officer Name: CITY OF GASTONIA / STEPHANIE SCHERINGER
Email Address: [e-mail]
Permittee Signature: Date: 3-d_ .A
ORC
Operator in Responsible Charge
Full Name: Justin Thomas Starnes
Email Address: [e-mail]
Work Phone: [phone]
Certificate Type: WW Certificate Grade: IV Certificate #: 1011369
Signature: Effective Date: 02 n;2`/
" ertify that I agree tc my de ignation 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."
Full Name:
Michael Charles Graham
Backup ORC
Certificate Type: WW Certificate Grade: IV
Work Phone: [phone]
Certificate #: 28534
Signature: /t� c . Effective Date: 6-12412pZ�z
"I certify that/ 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 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
Full Name: Kevin Morgan Graves Work Phone: [phone]
Certificate Type: WW Certificate Grade: IV Certificate #: 999374
Signature: Effective Date:
"I certify tha agree to my de gna on as a Back-up Operator in Responsible Charge for the facility noted. I understand and will
abide by the rules and regulati n 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 ORIGINAL to: WKSOCC, 1618 Mail Service Center, Raleigh, NC 27699-1618 1 FAX: [phone] [e-mail]
Mail or fax a COPY to: Mooresville-610 E. Center Ave., Suite 301, Mooresville, NC 28115 1 FAX: [phone] PH: 704-663-1699
Revised 312019

Facility Name: EAGLE ROAD WWTP
Permit #: NC0006033
Page 2
Full Name: Thomas Carlos Lopez Work Phone: [phone]
Certificate Type: WW I Certificate Grade: IV
Signature:
Certificate #: 1012910
Effective Date:
"Icertify thft 1 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."
Full Name: Edward Allen Walter
Certificate Type: WW Certificate Grade: Ili
Work Phone: [phone]
Certificate #: 1015502
Signature: Effective Date: 2
"1 certify that 1 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."
Full Name: Elisha Baker Jr. Work Phone: [phone]
Certificate Type: WW Certificate Grade: IV
Certificate #: 991684
Signature: "e-�CL
Effective Date: 2 2
"1 certify that/ agree to my designat n 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."
Be�MOt3
Full Name: Brent Richard Lucas Work Phone: [phone]
Certificate Type: WW Certificate Grade: IV Certificate #: 1011679
Signature: Effective Date: 0417el
"I certify that 1 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."

Full Name:
Certificate Type: Select Certificate Grade: Select
Signature:
Full Name:
Page 2
Work Phone:
Certificate #:
Effective Date:
"1 certify that 1 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."
Certificate Type: Select
Certificate Grade: Select
Work Phone:
Certificate #:
Signature: Effective Date:
°1 certify that 1 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."