NC0037508_Operator Designation Form_20040203

Water Pollution Control System ORC DesignatiOEFRinFR
WPCSOCC
NCAC 15A:08G .0201
FEB 0 6 2006
General Information: DWQ
Permittee Owner/Officer Name: Marcus Jones — Public Works Director
Mailing Address: PO Box 1927
City: Carthage State: NC Zip: 28327
Telephone Number: ( 910 ) 947-6315
Signature: %% ,% Date:
sato®eomo: -
Facility Information:
Facility: Moore County Water Pollution Control Plant
Permit Number:. NC0037508 County: Moore County
! SUBMIT A SEPARATE FORM FOR EACH TYPE OF SYSTEM !
Mark (X) Type of Facility Class (1 — 4) Class
Wastewater Plant X 4 Spray Irrigation . N/A
Physical/Chemical Land Application N/A
Collection System Subsurface N/A
Operator in Responsible Charge:
Print Name: James D. Frye- Superintendent Social Security # : 241-84-7332
Certificate Type and Grade: Wastewater IV Certificate #: 9831
Work Telephone: C.910J 281-3146 Signature:
Email: dfryeAmoorecountvnc.gov
Back -Up Operator in Responsible Charge:
Print Name: Jeffery W. Corder
Social Security # : 237-27-3533
Certificate Type and Grade: Wastewater IV Certificate #: 16856 Work Telephone: (_910J 281-3146 Signature:
Email: jcorder(a moorecountync.gov

Back -Up Operator in Responsible Charge:
Print Name: Bruce A. Turner Social Security #: 353-58-5074
Certificate Type and Grade: Wastewater IV Certificate #: 19193
Work Telephone: ( 910 ) 281-3146 . Signature:
Back -Up Operator in Responsible Charge:
Print Name:
Kenneth D. Chavis Social Security # : 244-54-8582
Certificate Type and•Grade: Wastewater III Ce ificate #: 14081
Work Telephone: _(910) 281-3146 Signature:
Mail or Fax to: WPCSOCC
1618 Mail Service Center
Raleigh, N.C. 27699-1618
Fax: [phone]
Revised 10/2000