NC0000272_ORCDES_20200729

WATER POLLUTION CONTROL SYSTEM OPERATOR DESIGNATION FORM
NCAC 15A 8G .0201
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Facility Name: Blue Ridge Paper Products - Evergreen Packaging Permit # NC0000272
Facility Type: VVW Facility Grade: IV 06,3'�,
i�A F AOCHCLASSIFICATION
Permittee Owner/Officer Name: Wallace McDonald
Email Address: Wallace.McDo
Permittee Signature:
Full Name:
Email Address:
Certificate Type: _Select
Signature:
everpacK.com
UL 2 9 2020
Asheville Regiunad Office 1 6 Date: (1_�,
ORC
Operator in Responsible Charge
Certificate Grade: Select
Work Phone:
Certificate #:
Effective Date:
"1 certify that I agree to my designation 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
Full Name: Kemmuel Brenning hyatt Work Phone: [phone]
Certificate Type: WVV Certificate Grade: III Certificate #: 1008172
Signature: J f Effective Date:
"1 certify that 1 agree to m, designation as a Back-up Operator in Responsible Charge for the facility Xoted1l understand and will
abide by the rules and regulations pertaining to the responsibilities of the ORC os 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."
Full Name:
Certificate Type: Select
Signature:
Backup ORC
Certificate Grade: Select
Work Phone:
Certificate #:
Effective Date:
"I certify that I agree to my designation as a Back-up 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."
Mail, fax or email ORIGINAL to: WPCSOCC, 1618 Mail Service Center, Raleigh, NC 27699-1618 1 FAX: [phone] [e-mail]
Mail or fax a COPY to: Choose DWR Regional Office that has coverage of this facility.
Revised 312019