NC0037311_Signature Authority_20200109

Creekside Manor Forsyth,LLC
6206 Reidsville Road
Kernersville,North Carolina 27284 • • A (r Vie• ' 1-a
January 9,2020
Wastewater Branch
WATER QUALITY PERMITTING SECTION RE,C E'
ED
DIVISION OF WATER RESOURCES
1617 Mail Service Center JAN 21 2020
Raleigh.North Carolina 27699-1617 NCDQI®WRINP®ES
Re: Delegation of Signature Authority
CREEKSIDE MANOR
NPDES Permit No. NC0037311
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
2110506.
Individual#1 Individual#2
Name: Jessica Mize Baron Neal McDuffie
Title: Administrative Assistant Field Services Manager
Mailing Address: 106 South Short Street 106 South Short Street
Kernersville,NC 27284 Kernersville,NC 27284
Physical Address:
(if different)
Email: [e-mail] mcduffie23@comcastnet
Office Phone: [phone] 336-996-2841
Mobile Phone:
1

If you have any questions regarding this letter,please feel free to contact me at(336) 595-6004.
Sincerely,
6/k44.1. 0,47
William Hammonds
Managing Member
[e-mail]
336-595-6004
Cc: File
Winston-Salem Regional Office-Water Quality Permitting Section
Research&Analytical Laboratories,Inc(R and A Labs)
2