NC0037508_Operator Designation Form_20200330

'ElkED
WATER POLLUTION CONTROL SYSTEM OPERATOR DESIGNATION f ;VVf SOCC)
NCAC 15A 8G .0201
Permittee-Owner/Officer Name:
Press TAB to enter information
Randy G. Gould - Public Works Director
Email Address:) [e-mail]
Permittee Signature:
Facility Name: Moore County Water Pdllution Control Plant
Date:
WQROS
-3z)
Permit # NC0037508
SUBMIT A SEPARATE FORM FOR EACH CLASSIFICATION OF SYSTEM: Facility Type: WW
Facility Grade: IV
OPERATOR INRESPONSIBLECHARGE
Print Full Name: Stephen Glenn Morgan
Certificate Type: WW Certificate Grade: IV
Email Address: [e-mail]
Work Phone:
Certificate #:
910-947-4345
997509
Signature: �✓�
Effective Date: 3 3 d . 4.7 0
"I certify that 1 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."
ACKURO
Print Full Name: James E. Newman
Certificate_Type:_1NW _
Email Address:
Signature:
Certificate Grade: IV
Work Phone:
910-947-4345
Certificate #:
1001848
Effective Date.
"/ certify that / afee 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 Fayetteville Mooresville
2090 US Hwy 70 225 Green St., Suite 714 610 E. Center Ave., Suite 301
Swannanoa, NC 28778 Fayetteville, NC 28301-5043 Mooresville, NC 28115
Fax: [phone] Fax: [phone] Fax: [phone]
Phone: [phone] Phone: [phone] Phone: [phone]
Washington Wilmington Winston-Salem
943 Washington Sq. Mall 127 Cardinal Dr. 45 W. Hanes Mill Rd.
Washington, NC 27889 Wilmington, NC 28405-2845 Winston-Salem, NC 27105
Fax: [phone] Fax: [phone] Fax: [phone] Phone:
Phone: [phone] Phone: [phone]
Raleigh
3800 Barrett Dr.
Raleigh, NC 27609
Fax: [phone]
Phone: [phone]
Revised 5/2019

Page 2
Facility Name: Moore County Water Pollution Control Plant
Permit #: NC0037508
CKUP.:o
Print Full Name: Bruce A. Turner
Certificate Type: WW
Email Address:
Signature:
Certificate Grade: IV
Work Phone: [phone]
Certificate #: 19193
Effective Date 1 74g ,2 2j
--"1-certify-that /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 O8G.0204 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
CKUP;fORi
Print Full Name: Michael N. Burket
Certificate Type: WW
Email Address:
Certificate Grade: IV
Work Phone: [phone]
Certificate #: 1009178
Signature: Effective Date: al,/ d 2'2 t l J
"1 certify that i agr e to my desi nation 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 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."
CKUP..O
Print Full Name: Jeremy C. Monroe
'Certificate Type: WW
Email Address:-- —
Signature:
Certificate Grade: IV
Work Phone: [phone]
Certificate #: 1009175
Effective Date:
7g
"1 certify that / agree my designation as a Back-up Operator in Responsible Charge for the facility noted. / understand and will abide by
the rules and regulat ons 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."
CKUP,:;ORC
Print Full Name: Johnny L. Cummings
Certificate Type: WW
Email Address:
Signature:
Certificate Grade: III
Work Phone: [phone]
Certificate #: 1007636
Effective Date: 3. go,. iqn
"1 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 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."
Revised 5/2019