DEQ-CFW_00061293

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DuPont Fluoroproducts
22828 NC Highway 87 W
Fayetteville, NC 28306-7332
December 9, 2009
WPCSOCC
1618 Mail Service Center
Raleigh, NC 27699-1618
Subject: Designation of Back -Up Operator in Responsible Charge
DuPont Company — Fayetteville Works
NPDES Permit No. NCO003573
Dear Sir or Madam:
Enclosed is the new Water Pollution Control System Operator Designation Form for the
DuPont Company — Fayetteville Works facility.
If you should have any questions, please feel free to call me at [phone].
Michael E. Johnson
Environmental Manager
Enclosure
cc: Ms. Belinda Henson, NCDENR DWQ, FRO
E.I. du Pont de Nemours and Company
DEQ-CFW 00061293

Water Pollution Control System Designation Form
WPCSOCC
NCAC 15A 8G .0201
Permittee Owner/Officer Name: Karen B. Wrigley — Plant Manager
Mailing Address: 22828 NC Highway 87 W -
City: Fayetteville State: NC Zip: 28306-7332 Phone #: [phone]
Signature: �, L- '� i �'= ��- -+-.�� Date:
1
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Facility Name: DuPont Company - Fayetteville Works Permit #: NC0003573
! SUBMIT A SEPARATE FORM FOR EACH TYPE OF SYSTEM!
Facility Type & Grade
Grade Grade
Biological WWTP 3 Surface Irrigation N/A
Physical/Chemical N/A Land Application N/A
Collection System N/A
Operator in Responsible Charge (ORC):
Print Full Name: Jamie Ray Lewis -
Certificate Type / Grade / Number: WW / Grade 3 / 994024 Work Phone #: [phone]
Signature: L I
"I certify that I agree to my designation as the 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."
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Back -Up Operator in Responsible Charge (BU ORC):
Print Full Name: Arnold Ray Beard -
Certificate Type / Grrade / Number: WW / Grade 2 / 28791 Work Phone #: [phone]
Signature:
"I certify that I agree to my designation as the 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."
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Mail or Fax to: WPCSOCC
1618 Mail Service Center
Raleigh, N.C. 27699-1618
Fax: [phone]
(See next page for designation of additional back-up operators. Designation of more than one back-up operator is optimml.)
Revised 1-2008
DEQ-CFW 00061294

Additional Back-up ORC designations
Facility Name: DuPont Company - Fayetteville Works Permit #: NC0003573
Back -Up Operator in Responsible Charge (BU ORQ:
Print Full Name: Robert J. Geddie Jr.
Certificate Type / Grade / Number: WW / Grade 4 / 15566 Work Phone #: [phone]
Signature: - C ie, Gaye- ®dt. `f %(e-
"I certify that I agree to my designation as the 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."
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Back -Up Operator in Responsible Charge (BU ORQ:
Print Full Name: E. Russell Rotan
Certificate Type / Grade / Number: WW / Grade 3 / 21886 Work Phone_#: [phone]
Signature:
"I certify that I agree to my designation as the 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."
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Back -Up Operator in Responsible Charge (BU ORQ:
Print Full Name:
Certificate Type / Grade / Number:
Signature:
Work Phone #:_
"I certify that I agree to my designation as the 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."
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Back -Up Operator in Responsible Charge (BU ORQ:
Print Full Name:
Certificate Type / Grade / Number:
Work Phone
Signature:
"I certify that I agree to my designation as the 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."
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Revised 1-2008
DEQ-CFW 00061295