NC0032778_Signature Authority_20200114

July 9,2019
RECEIVED
Wastewater Branch JAN 14 Zp20
Water Quality Permitting Section
Division of Water Resources NCDEQIDWWNPDES
1617 Mail Service Center
Raleigh,NC 27699-1617
Subject: Delegation of Signature Authority
ENTER FACILITY NAME
NPDES Permit Number NCO I C-F.Ol
To Whom It May Concern: kcoo3p, 11�
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
the subject facility 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.
Individual#1 Individual#2 (if applicable)
Name: g AA.rA Green.. .3;w,rv►.it aJ WIu. I f'
Title: 0,2.C. IEZAT'a' r i, r g- ?GRIT o1E?RTo .
d Qu o
Mailing Address: ,I11Ai87 I re 3as- £( O
b/,9� a.n.d4 iy
146144.44-NDs rac .2 ir 7 y l
Physical Address:
(f different)
Email Address: ri chard.. Lt raer� @ht L rt •or
9 °� c g 3;h1 •Mwbl /-i;i{,la.ndSnC . ar4'
Office Phone: it)e- Sad 1 i es . tor/-S�6 :lies �!
Mobile Phone: - - - -
If you have any questions regarding this letter,please feel free to contact me at Enter Email or Phone
Number.
Sincerely,
Authorized Signing Official's Name _joSN0A t?.t„)A,2f e v1/4)�
Authorized Signing Official's Title -re,,,,) rd1A1.3P,G.L,
Mailing Address p D. Got yc4,0 i Wa.o-rF aDS 0 G 2.6„,11
Email Address �o 11.vJ�Zp @ rlusrt�na+ c..3 2 G
Office Phone ($2�� SZ(D-Zit
Mobile Phone
cc: Select a region Regional Office,Water Quality Permitting Section

E. Submitter Signature
The Submitter(electronic signature applicant)is a user other than the Responsible Official who submits
this agreement to request to sign reports electronically. The Submitter is given signatory authority by an
individual identified as the Responsible Official by the Owner/Organization to sign reports and other
information and to accept electronic documents.
I, Ri‘O/� ,een.. (printed name), am authorized by the Responsible Official
name in this document,who does have the autho i under the applicable standards,to enter into this
agreement for /�t`p�j,p,,,d S Wc��2t— I iaid- (Owner/Organization Name).
By submitting this application,I, R ismaws } r-pe,A_ (printed name),have read,
understand,and accept the terms and conditions of this Electronic Signature Agreement. I certify under
penalty of law that I have personally examined and am familiar with the information submitted in this
application and all attachments and that,based on my inquiry of those persons immediately responsible
for obtaining the information contained m the application,I believe that the information is true,accurate
and complete.I am aware that there are significant penalties for submitting false information, including
the possibility of fine and imprisonment.
Submitter Signature Title Date
r;Gd r ► 5ceex 1i:51A as c_us ?ae-. d (0��21�5
Email Address Phone Number
*email will be the primary method of contact for the electronic submittal process so it is important to have an accurate email
available at all times
If you are a current eDMR submitter please provide your User Id:
g User Id
PI
Subscribed and sworn to before me this on day of 9„4„,,,,,1 , 20 av .
ature of Notary Public
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B tC.( S % Printed Name of Notary Public
cc— My My Commission Expires: 3 Sic: 0
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NCDWR Electronic Submittal Agreement Version 1 Page 5