NCG030433_Email re Delegation of Authority_20210421

McCoy, Suzanne
From: Janie Dzuricky <[e-mail]>
Sent: Wednesday, April 21, 2021 1:10 PM
To: McCoy, Suzanne
Subject: [External] Stormwater Delegation of Authority - NCG030433, NCG030541
Attachments: 20210421130238173.pdf
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Ms. McCoy,
Please find attached the Stormwater Delegation of Authority forms for Cree, Inc. permits in Durham
County: NCG030541 and NCG030433.
The hard copy will be mailed out today, using Certified Mail (7020 2450 0001 5241 9567).
Thank you,
Janie
Janie Dzuricky
Environmental Engineer I Environment, Health & Safety
R E E = Woffspeed,
www.cree.com www.wolfspeed.com
4600 Silicon Dr., Durham, NC 27703
0: [phone] M: [phone]
(she/her)
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NC Department of Environmental Quality
Division of Energy, Mineral and Land Resources
NORTH CAROLINA
Environmental Quality
Stormwater Permit Delegation of Signature Authority Form
Directions are in red.
� This form shall be used to delegate signature authority from the permit Owner (Permittee) to
another party. Only the Responsible Official defined below may submit permit applications and
reports required by the permit (such as Data Monitoring Reports and Annual Reports) until this
form is completed and submitted to the DEMLR Stormwater Program. Please note that delegating
signature authority does not relieve the Permit Owner from the responsibility for permit
compliance.
� The permit Owner is the legal entity to which/whom a permit has been issued, and maybe an individua!
or an organization such as a company or government agency. Every Owner is required to have a
Responsible Official who meets the legal signature authority requirements in 40 CFR 122.22, summarized
below:
• For a corporation, the Responsible Official shall be a president, secretary, treasurer, or vice-
president in charge of a principal business function, or another individual who performs similar
functions for the corporation, or the manager of one or more manufacturing, production, or operating
facilities who is authorized to make management decisions about the facility operation.
• For a partnership or sole proprietorship, the Responsible Official shall be a general partner or the
proprietor, respectively; or
• For a municipality, State, Federal, or other public agency, the Responsible Official shall be either a
principal executive officer (City/County Manager] or ranking elected official (Mayor].
� Even if delegated signatory authority has been delegated to another individual, the Responsible Official
retains responsibility for compliance with permit conditions.
Permittee:
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Permit Number:
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Responsible Official Title:
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Email Address:
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Phone:
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Mailing Address:
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City:
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State:
NC
Zip:
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Stormwater Delegation of Signature Authority Form
Page 1

A. Persons to Receive Signatory Authority
* The signatures o, the persons listed below indicates their acceptance of signatory authority.
Delegated Party Name:
OAS
Delegated Party Title:
Delegated Party Organization:
Email Address:
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Phone:
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Mailing Address:
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City:
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State:
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Zip:
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Signature of Delegated Party indicating
acceptance of Signatory Authority:
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Date:
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Delegated Party Name:
Delegated Party Title:
Delegated Party Organization:
Email Address:
Phone:
Mailing Address:
City:
State:
Zip:
Signature of Delegated Party indicating
acceptance of Signatory Authority:
Date:
Delegated Party Name:
Delegated Party Title:
Delegated Party Organization:
Email Address:
Phone:
Mailing Address:
City:
State:
Zip:
Signature of Delegated Party indicating
acceptance of Signatory Authority:
Date:
Delegated Party Name:
Delegated Party Title:
Delegated Party Organization:
Email Address:
Phone:
Mailing Address:
City:
State:
Zip:
Signature of Delegated Party indicating
acceptance of Signatory Authority:
Date:
Stormwater Permit Delegation of Signatory Authority Form
Page 2

B. Responsible Official Signature
The Responsible Official, as identified in accordance with 40 CFR 144.44, is the appropriate
individual with the authority to sign and submit reports for the organization.
As the Responsible Official, I,
have the authority to enter into this Agreement for
r� f Ln c . (Owner/Organization Name).
(printed name),
I request that the DEMLR Stormwater Program include the persons listed in Part A of this form
signatory authority for the above -named permit.
I acknowledge that I, and the persons listed in Part A of this form work at/for my organization
and have authority to act as a signatory for purposes of the NCDEQ's electronic document
systems.
By submitting this application, I,
have read, understand, and accept the terms and
which I am the Responsible Official.
Title
�o� JZ (printed name),
ns of the stormwater permit(s) for
Date
Stormwater Permit Delegation of Signatory Authority Form
Page 3