NC0034959_Signature Authority_20141010

NPDES DOCUMENT SCANNING COVER !SHEET
NPDES Permit:
NC0034959
West Rowan High School WWTP
Document Type:
Permit Issuance
Wasteload Allocation
Authorization to Construct (AtC)
Permit Modification
Complete File - Historical
Engineering Alternatives (EAA)
.......„ v.... —_______ __
L
Signature Authority
Instream Assessment (67b)
Speculative Limits
Environmental Assessment (EA)
Document Date:
October 10, 2014
This document is printed on reuse paper - ignore any
content on time reirerse side

Qctober71.0, 2014
Wastewater Branch
Water Quality Permitting Section
Division of Water Resources
647 Mail Service. Center
lt'al'eigk. NC: 27699-16.17
Subject:
Delegation of Signature Authority
West Rowan High School
NPDES Number NC0034959
To Whom It May Concern:
RECEIVED/DENR/DWR
OCT 2 0 2u14
Water uuainy
Permitting Section
i r notice: villas. letter, i hereby delegate signatory authority to each of the following
i dh:vid fOralll permit applications, discharge monitoring reports, and other information
Orating to the operations at: West Rowan Higb School as required by all applicable federal,
state, and. focal environmental. agencies specifically with the requirements for signatory
authority as specked in 15A NCAC• 2B.0506.
Name 'Title
i!od"y Blythe Wells Pesticide
lfyou haveany questions regarding this letter, please feel free to contact me at.
Siicereliy„
�✓. �,--mob--
D�. L,nm Moody
Superintendent
cc: h�ooresville Regional Office, Water Quality Permitting Section

v
October 10; 2014.E
, Wastewater Branch
Water Quality Permitting, Section
.,, ,,.f":isiom of Water Resources
t - .16 f7 Mail Service. Center
Raleigh,. NC 276991617
Sub ;ectr Delegation of Signature Authority
West Rowan High School.
NPDES Number NC0034959
To Whom: It May Concern:
By notice: of. tiis.. letter, 1 hereby delegate signatory authority to each of the following
iaad tci'dhal's: for►anti permit applications, discharge monitoring reports, and other information
relating, to' the operations. at. Nest Rowan High School as required by all applicable federal,
stater and toed environmental agencies specifically with the requirements for signatory
authority as specified in 15A NCAC 2B.0506.
Name Title
Jody Blythe Wells Pesticide
1 you: have. any questions regarding this letter, please feel free to contact me at.
Siaicereliy,.
A(.4"-"V-
1r�tnt-Moody
Super, tntenutent
cc:: Mooresville Regional Office, Water Quality Permitting Section

it
S)
Submitter Change Request Form — (Add/update users)
North Carolina Electronic Discharge Monitoring Report System
EDMR registered Owners may use this form to add or update eDMR users to the NCDWR's Electronic
Discharge Monitoring Report system. If the Organization is not currently registered for eDMR, then the
Owner or designated Responsible Official will need to complete the required eDMR Registration Form
(available from the eDMR website) and submit it to the NCDWR eDMR Administrator at the address
below.
Type of Request (please select):
X Add Submitter Permissions: (See Section B)
Update Submitter Permissions: (See Section B)
To add or update eDMR user permissions, please provide the following information:
Sectipn A: Owner Information
RECEIVED/DENRIDWR
OCT 2 0 iu €"
Water kituas+tyy.
Permitting Section
NPDS Permit Number:
NC0034959
Owner / Organization Name:
Rowan -Salisbury Schools
Responsible Official
(as identified in accordance with 4Q CFR„ 17,2,22)
B.H. B lve ns
Street Address:
8050 Nc Hwy 801
City: •
Salisbury
State / Zip Code: -
NC 28125
Telephone number:
(704) 8573400
E-mai address:
[e-mail]
Section B: Activate New Submitter or Update Existing User
Please complete the Submitter User Details on page 2 for the individuals who will need Submitter
permissions or to update Submitter details, such as adding additional permits, to an existing user.
Submitter permissions can only be assigned by the NCDWR eDMR Administrator. Note: The Owner
and Faclllty Administrator can deactivate or delete eDMR user permissions for any individual within
its orgaiizalion, including Submitter permissions.
The Su/mister is equivalent to the individual who signs the certification statement on the back of the
Discharge Monitoring Report. The Submitter must be an individual with delegated signatory authority
for the Owner/Organization. if individuals other than the Responsible Official for the Owner have been
delegated signatory authority, the Division of Water Resources must be notified in writing of such
delegations. A delegation of authority form is available from the eDMR website.
In addition to the User Details, please specify the NPDES permit(s) that each user will be associated with
for eDrs R submittal. Should additional space be needed for users and/or permits, please make additional
copies of the Submitter User Details page and complete as needed.
NCDWR eDMR Submitter Change Request Form ver. 1.0
Page 1

Submitter User Details
Permit No. (s):
NCO034703
NC0034959
First Name:
Jody
Middle Name:
•
Last Name:
,Blythe
Phone Number:
(704) 8573400
Email:
•
blythejl@rss.k12,nc.us
User ID:
(Assigned by NCDWR eDMR Administrator)
• SeleetRequest.
Type:
Cit Add User Permission
, Add/Update User Permission as of(Date):
• Update User Permission
Submitter User Details
Permit No. (s):
First Name:
Middle Name:
Last Name:
Phone Number:
( )
Email:
User ID:
(Assigned by NCDWR eDMR Administrator)
Select Request
Type:
0 Add User Permission
Add/Update User Permission as of (Date):
Cl Update User Permission
Submitter User Details
Permit No. (s):
First Name:
Middle Name:
Last Name:
Phone Number:
( )
Email:
User ID:
(Assigned by NCDWR eDMR Administrator)
Select Request
Type:
Add/Update User Permission as of (Date): .
• Add User Permission
• Update User Permission
NCDWR eDMR Submitter Change Request Form - ver. 1.0
Page 2

Submitter User Details
Permit No. (s):
NC0034703
NC0034959
REC�EIVED/DENR/DWR
First Name:
Jody
Middle Name:
p C T 2 0 1 tl 14
Last Name:
Blythe
Water uuattry
Phone Number:
(704) 8573400
Permitting Section
Email:
[e-mail]
User ID:
(Assigned by NCDWR eDMR Administrator)
Select Request.
Type:
It Add User Permission
Add/Update User Permission as of(Date):
• Update User Permission
Submitter User Details
I
PermitiNo. (s):
First Name:
Middle Name:
Last Name:
Phone Number:
(, )
Email: 1
i
User ID:
(Assigned by NCDWR eDMR Administrator)
Select Request
Type: 1
0 Add User Permission
Add/Update User Permission as of (Date):
• Update User Permission
Submitter User Details
Permit No. (s):
First Name:
i
Middle lame:
Last Name:
Phone Number:
( )
Email:
User ID:
(Assigned by NCDWR eDMR Adnilnlstraror)
Select Request
Type:
• Add User Permission
Add/Update User Permission as of(Date):
• Update User Permission
NCDWR eDMR Submitter Change Request Form - ver. 1.0
Page 2

Responsible Official Authorization
The Responsible Official, as identified in accordance with 40 CFR 122.22, is the appropriate individual
with the authority to sign reports for the organization.
I, Dr. Lynn Moody (printed name), have the authority to make this request for
Rowan -Salisbury Schools (Owner/Organization Narne).
•
[ request the NCD,WR add or update the eDMR Submitter user permission(s) as indicated above on the
Submitter User Details page.
i7k ',SyC.f• nit., (,-►i AO - / 7 - y
/
Owner/ °
ponsible Official Sig ature Title Date
Please return the completed form to the NCDWR eDMR Administrator via:
Fax: or E-mail: or Mail to:
[phone] [e-mail] Information Processing Unit
Attn: eDMR Registration
1617 Mail Service Center
Raleigh, NC 27699-1617
NCDWR eDMR Submitter Change Request Form - ver. 1.0
Page 3