NC0044750_Signature Authority_20200109

January 9, 2020
Wastewater Branch JAC O B'S CREEK
Water Quality Permitting SectionNursing &Rehabilitation Center
Division of Water Resources
1617 Mail Service Center
Raleigh,NC 27699-1617 �� NED
E
1`��
Subject: Delegation of Signature Authority JAN 21 2020
JACOBS CREEK NURSING
NPDES Permit Number NC0044750 NOO Q/DWR/NPDES
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
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: Jessica Mize Baron Neal Mcduffie
Title: Administrative Assistant � Field Services Manager
106 Short Street Kernersville,Nc 106 Short Street Kernersvile; Nc
Mailing Address 27284 27284
Physical Address
(if different)
Email Address [e-mail] [e-mail]
Office Phone: 336 - 996 - 2841 336 - 996 - 2841
Mobile Phone - - - -
If you have any questions regarding this letter, please feel free to contact me at 336-548-9658.
Sincerely,
Darren Bullins pECtirSAIZ-6
Maintenance
Jacob's Creek Nursing & Rehab
1721 Baldhill Loop Rd. Madison,Nc
[e-mail]
336-548-9658
cc: Winston-Salem Regional Office,Water Quality Permitting Section
1721 Bald Hill Loop • Madison, NC 27025-7624 • Phone [phone] • Fax [phone]