NC0084832_Signature Authority_20200226

- RESEARCH & Ai NAtyliCAi. Sent Via UPS Ground
;,; LAboRATo IES, INC. DJVIR Checklist Tracking# 1Z 209 959 03 5322 3315
' '-'E•• �`t< AnalytIcat/Process Consultations
Page: 1 of 1 Prepared by JM
Date: 2/18/2020 Checked by JM
Attention: Wastwater Branch/Water Quality Permitting Section/Division of Water Resources
Discharge Monitoring Report-(DMR) - System ID# Discharge# Checked by Checked
Nikola's Restaurant&High Meadows Inn NC0084832 001 L O
Wastewater Branch
Water Quality Permitting Section
Division of Water Resources
1617 Mail Service Center
Raleigh,NC 27699-1617
RECEIVED
FEB 2 6 2020
NCDEQ/DWR/NPDES

January 7,2020
Wastewater Branch -
Water Quality Permitting Section - —
Division of Water Resources
1617 Mail Service Center
Raleigh,NC 27699-1617
Subject: Delegation of Signature Authority
NIKOLA'S RESTAURANT
NPDES Permit Number NC0084832
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 Kernersville,Nc
Mailing Address: 27284 27284
Physical Address:
(if dferent)
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 336-363-2221.
Sincerely,
(e0 Ye7,62_3
Zdenko Peros
Owner
Nikolas Restaurant&High Meadows Inn
10498 Highway 21 South Roaring Gap,Nc
[e-mail]
336-363-2221
cc: Winston-Salem Regional Office,Water Quality Permitting Section