NC0049867_Change of ORC_20210301

Strickland, Bev
From: [e-mail]
Sent: Monday, March 1, 2021 3:47 PM
To: SVC_DENR.certadmin
Cc: Scheller, Roberto
Subject: [External] New ORC
Attachments: WWTP ORC-2-2021.pdf
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Please find attached the form to show John Walter Richie as the ORC for the Town's WWTP. Our backups did
not change.
Thank you,
Cathy Payne, CMC, CLGFO
Town Clerk/Finance Officer
Town of Cleveland
704-278-4777
[e-mail]
1

WATER POLLUTION CONTROL SYSTEM OPERATOR DESIGNATION FORM (WkSOCC)
NCAC 15A 8G .0201
Press TAB to enter information
Permittee Owner/Officer Name: Patrick Phifer
Email Address: [e-mail]
Permittee Signature:
Facility Name: Town of Cleveland WWTP
SUBMIT A SEPARATE FORM FOR EACH SYSTEM CLASSIFICATION: WW-II
Date: p2 /26 /22/
Permit #
NC0049867
ORC - OPERATOR IN RESPONSIBLE CHARGE
1�c j� r
Print Full Name: f�y� Wa!/f � r / 1'eJ
Certificate Type: WW Certificate Grade: IV Certificate #:
Jr; ier7,W3k ,/
Email Address:
Signature:
Work Phone:
Effective Date:
704-310-1787
"1 certify that 1 agree'4d my designation as the Operator in Responsible Charge far 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 086 .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:
Certificate Type: Select
Email Address:
Signature:
Certificate Grade: Select
Work Phone:
Certificate #:
Effective Date:
"1 certify that 1 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
Email: [e-mail] Fax: [phone]
Mail or Fax a COPY to: 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
610 E. Center Ave., Suite 301
Mooresville, NC 28115
Fax: [phone]
Phone: [phone]
Winston-Salem
45 W. Hanes Mill Rd.
Winston-Salem, NC 27105
Fax: [phone] Phone:
336-776-9800
Raleigh
3800 Barrett Dr.
Raleigh, NC 27609
Fax: [phone]
Phone: [phone]
Revised 11/2020