NC0032719_Email (ORC Form)_20190730

Strickland, Bev
From: Tawes, David
Sent: Tuesday, July 30, 2019 4:57 PM
To: SVC DENR.certadmin
Cc: Tankard, Robert; Sipe, Randy; May, David; Howard, Kevin B
Subject: Chowan County - Valhalla WTP NCO032719
Attachments: 30-07-2019 WW ORC Form.pdf
Hi,
Please see the attached form.
Thank you,
David
David M. Tawes
Chowan Water
1608 Virginia Road
Edenton, NC 27932
Office [phone]
[e-mail]
Email correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties by an authorized
state official.

WATER POLLUTION CONTROL SYSTEM OPERATOR DESIGNATION FORM (WPCSOCC)
NCAC 15A 8G .0201
Press TAB to enter information
Permittee Owner/Officer Name: Chowan County Manager / Kevin Howard
Email Address: [e-mail]
Permittee Signature: �— 11 Date: ?
,-----
Facility Name: Valhalla WTP
Permit # NCO032719
SUBMIT A SEPARATE FORM FOR EACH CLASSIFICATION OF SYSTEM: Facility Type: PC
Facility Grade: I
ORC - OPERATOR IN RESPONSIBLE CHARGE
Print Full Name: David Tawes Work Phone: [phone]
Certificate Type: PC Certificate Grade: I Certificate #: 985392
Email Address: [e-mail]
Signature: Effective Date:
"I certify that 1 agree to my Jesignation 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."
BACKUP ORC
Print Full Name: Doremus Luton Work Phone: [phone]
Certificate Type: PC Certificate Grade: I Certificate #: 992054
Email Address: [e-mail]
Signature: `��� Effective Date: 7 - 3 U ^ j 7j
"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 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:
Mail or Fax a COPY to:
WPCSOCC, 1618 Mail Service Center, Raleigh, NC 27699-1618
Email: [e-mail] Fax: [phone]
Asheville
2090 US Hwy 70
Swannanoa, NC 28778
Fax: [phone]
Phone: [phone]
Washington
943 Washington Sq. Mall
Washington, NC 27889
Fax: [phone]
Phone:[phone]
Fayetteville
225 Green St., Suite 714
Fayetteville, NC 28301-5043
Fax: [phone]
Phone: [phone]
Wilmington
127 Cardinal Dr.
Wilmington, NC 28405-2845
Fax: [phone]
Phone: [phone]
Mooresville Raleigh
610 E. Center Ave., Suite 301 3800 Barrett Dr.
Mooresville, NC 28115 Raleigh, NC 27609
Fax:[phone] Fax:[phone]
Phone:[phone] Phone:[phone]
Winston-Salem
45 W. Hanes Mill Rd.
Winston-Salem, NC 27105
Fax: [phone] Phone:
336-776-9800 Revised 512019