NCG500323_Regional Office Historical File Pre 2018 (54)

rsthurtape
J U N 2 5 2009
24 June 2009
WPCSOCC
1618 Mail Service Center
Raleigh, NC 27699-1618
Subject: NPDES PermitNo. NCO072664
ORC / Back -Up ORC Designation Form
Shurtape Technologies, LLC. Stony Point Plant
Alexander County
Please find attached anupdated ORC Designation for the subject facility. As the attached form
indicates, Travis Brannon will be the ORC, and Doug Hall will be the backup ORC for the referenced
facility. Previous ORC, Jeff Roseberry, will be removed from the list entirely. This form should be
considered effective as of today's date (June 24, 2009). Should you have any questions or concerns,
please contact me at [phone] or via email at [e-mail].
Respectfully yours,
k,
Mark E. Hawes, P.E.
Director of Environment & Safety
Enclosures
cc: Wes Bell, w/ enclosures
Barbara Sifford, w/ enclosures.
David Neff, w/ enclosures
Matt Moore, w/ enclosures
Travis Brannon, w/ enclosures
1
Shurtape Technologies, LLC PO Box 1530 Hickory, NC 28603 w mAurtapexom

Water Pollution Control System Operator `6 gnAtion
-6 Form
WPCs®cC
NCAC 15A SG .0201 U U N 2 5 2009
Permittee Owner/Officer Name: Shurtape Technologies, LLC / David Neff, Plant Manager
Mailing Address: P.O. Box 48 / 8510 NC Highway 90 East
City:Ston t State: NC Zip: 28678 _ Phone #: [phone]
Signatu 1 Date: ZI 2 D
..............................................................................................................................................
Facility Name: Shurtape Technologies, LLC - Stony Point Facility
! SUBMIT A SEPARATE FORM FOR EACH TYPE OF SYSTEM!
Facility Type & Grade:
Permit #: NCO072664
County: Alexander
Type Grade Type Grade
Biological WWTP X II Surface Irrigation N/A
Physical/Chemical N/A Land Application N/A
Collection System NIA
......................................................................................................................,
Operator in Responsible Charge (ORC)
Print Full Name: Travis Edwin Brannon
Certificate Type /Grade / Number: . Biological WPCGIII990808 9 -Work Phone #: (704 ! 585-6517
Signature: Date:�—
"I certify that I agree to my designation as the 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
Disciplinaty,Actions by the Water Pollution Control System Operators Certification Commission."
.................................. :.......................................... ......... ........................................................
Back -Up Operator in Responsible Charge (BU ORC)
Print Full Name: Doug Hall
Certificate a /Grade /Number: Biological WPC, Gil, 991096. Work Phone #: (/ it 585-6511
Signature: Date:
"I certify that I 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 BU ORC as set forth in 15A NCAC 08G .0205 and failing to do so can
result in Disciplinary Actions by the Water Pollution Control System Operators Certification Commission." .
Mail or Fax.to: WPCSOCC
1618 Mail Service Center
Raleigh, NC 27699-1618
Fan: 919n33-1338
(See next page for designation of additional back-up operators. Designation of more than one back-up operator is optimud.)
Revised 8-2007 . .
i