NC0020656_Delegation of Signature Autrhority_20121112

OFFICE OF THE TREATMENT PLANTS DIRECTOR
November 12, 2012
Point Source Branch
Surface Water Protection Section
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617 •
Subject: Delegation of Signature Authority
City of Laurinburg/Leith Creek WWTP
NPDES No. NC0020656
City of Laurmburg Wafer
NPDES No NC00367 7S''
is
Pilkington,North American
NPDES NO:NC002166
By notice of this letter, I -hereby delegate signatory ach authority to eof the following
individuals for all permit applications, discharge monitoring reports; `and other
information relating to theoperations atR1e"W Itki CreelWTP, Cityfof Eaurinburg Water
Plant and Pilkington North Ainerican.as required by all applicable federal, state, and local
environmental agencies specifically. with the requirements for signatory authority as
specified in 15A NCAC 2B.0506
DENR-FRO
DEC 052012
All-AfflovicaCEI
•
Name
Robert A. Ellis, Treatment Plants Director
If you have any questions regardingjth s letter-, pleasefeel free to contact me at 910-277-
0214.
Edward F. Burchins
City Manager
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603 LAUCHWOOD DRIVE a P.O. BOX 249 ® LAURINBURG, N.C. 28353 PHONE: [phone] ® FAX: [phone]

•".To preserve, protect
and enhance
North Carolinas. wafer..."
North Carolina (NC) eDMR Reports
eDMR Registration Form
eDMR is an electronic reporting system, which will provide a facility Owner the ability to submit
discharge monitoring reports via the internet. eDMR is only currently available to facilities that
have an NPDES Wastewater permit issued by the Division of Water Quality. Registration for
eDMR must be completed by the legal Owner of the facility(s), and this legal Owner must be the
same Owner to which the permit(s) have been issued. Once an Owner is registered for eDMR, all
permits held by the Owner will also be registered and able to submit reports via eDMR.
NOTE: Before completing and submitting the registration form, the legal Owners as specified
above should verify the permit facility, ' Owner, and ORC designations for all permits. This
information can be verified using the eDMR Owner Information Search provided on the
eDMR website. This information is maintained in the DWQ data management system, as
provided by the permittee, and contained in the permit issued to the Owner. Should any
discrepancies with this information be determined, the appropriate DWQ_contact should
be notified so information can be corrected prior to registration. It is important that the
permit information be correct prior to eDMR registration.
Please provide all information in Part A, B, C and D. An Owner signature is required for
eDMR registration. Should the registration information be incomplete, the registration
process may be delayed.
Part A: Owner Registration — Permit/Facility Information
Please provide a Permit Number and the associated facility information Only a single:permit
number is needed'f stration If multiple peimrts are ,involved, the permitnu nber' piovided
will cbe used to. identify.the Owner and all: associated permi_ is !! All associated permits issued to the
Owner will be registered for eDMR.
r n[it'Num er:
NICI01012101615161
City of Laurinburg
Leith Creek WWTP
P. O. Box 249
Laurinburg
28353
NC
NC eDMR Registration Form (Revision 3)
• Page 1 of 4

Part B: Owner Registration - Owner User Details:
Please provide the following information which is needed for creating the Facility Owner in
eDMR. The Owner is the legal entity to which the permit(s) have been issued and may be an
organization or individual. For an organization, the information provided for the owner details should
be the official contact person or the person with delegated signatory authority for the Owner.
Burchins
F.
Edward
malt;
ser`'
e bunch; D S l a.L.r; n d i _05 : b r9
(Assigned by DWQ eDMR Administrator)
Part C: User Account Information — Submitters
Please provide the users, in addition to the Owner, who will need Submitter permissions.
Submitter permissions can only be assigned by the DWQ eDMR Administrator. The Owner specified
above will be given full eDMR permissions including Submitter permissions.
The Submitter is equivalent to the individual who signs the certification statement on the back of the
discharge monitoring report. In most cases, the Submitter will be the Owner but may be other
delegated individuals. The Submitter must be an individual with delegated signatory authority. If
individuals other than the duly authorized person for the Owner have been delegated signatory
authority, the Division of Water Quality 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 permit(s) that each user will be associated with for
eDMR 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.
NOTE: The Owner will be responsible for creating all facility users except those with Submitter
permissions.
In addition to the Owner and Submitter user, there are four additional user types identified
by user permission level: Facility Administrator, Certifier,' Data Entry and View Only.
The Owner and Facility Administrator will have the ability to manage facility users. The
Facility User Administration Guide will provide the appropriate procedures for facility user
management.
NC eDMR Registration Form (Revision 3) Page 2 of 4

Submitter User Details
Permit No. (s)
NC b0ao(a/1)
NfC063113
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First Name:: : ::
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Middle Name:
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-Last" Name "
S P I E CE
-PhoneNumber:
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Email:Ssai
eye p tale i nbun i, oral
User ID
(Assigned by DWQ eDMR Administrator)
Submitter :User Details
Permit No. (s)
First Name:;
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NC 01)3‘01.13
flC&oatpcol
Middle Name:
Last Name:
.,'Phone Number
Email:
Ottorn
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User ID:
(Assigned by DWQ eDMR Administrator)
Submitter User`,Details
"Permit No..
First Name:.
:Middle, Name:- '
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A.
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Last Name:
Phone `Number:
Email:•
ELLIS
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User
(Assigned by DWQ eDMR Administrator)
,Submitter User Details.;',,;,
ermit No:
Middle' Name
ast Naive:
one Nolo
°User
(Assigned by DWQ eDMR Administrator)
NC eDMR Registration Form (Revision 3)
Page 3 of 4

Part D: Registration Certification:
I request the facility identified above be allowed to submit DMR data using the NC DWQ eDMR
system.
I understand that electronic submittal of the DMR does not fully satisfy US EPA 's electronic signature
requirements and as a result, I understand I will be required to print, sign, and submit hardcopies
(one signed original and a copy) of the eDMR to NC DWQ under the same reporting requirements as
paper -based DMRs as specified in Part II, Condition D(2) of the NPDES Permit.
I agree to protect the security of my user ID and password from compromise and shall take all
necessary steps to prevent its loss, disclosure, modification, or unauthorized use.
E :A(Z Z a gs
Owner(Peri ' t-) ame (type or print) Official Title (type or Print)
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/ /3// ,
Owner (Permittee) Signature Date
Please return the completed Registration Form to the NC Division of Water Quality
Fax:
or Email: or Mail to:
[phone] eDMRadmin(a,ncdenr.gov
Information Processing Unit
Attn: eDMR Registration
1617 Mail Service Center
Raleigh, NC 27699-1617
NC eDMR Registration Form (Revision 3) Page 4 of 4

DENR-FPS`
OFFICE OF THE TREATMENT PLANTS DIRECTOR
December 27, 2012
NC Dept. of Env. & Natural Resources
Attention: Belinda S..Henson
225 Green Street, Suite 714
Fayetteville, NC 28301
Re: Notification of Name Change
NPDES Permit No:{NC002065
NPDES Permit No NC0021661
NPDES. Permit.No NC003677;
D C arMs.r Henson:
iSitt, of CaUrwfur9 "oCw„"1'
RYAisIE804'
19'1111'
6
This letter is to notify you that our City^Manager Edward Burchins is no longer with the
City of Laurinburg and councilxhas appointed an Interim City Manager, Harold
Haywood. Please address;>any future correspondence t9:
Harold Haywood;
Interim City Manage
Box 249
Laurnbar
He will also be signing our monthly monitoring reports until further notice. If you have
any questions please contact me at the number below.
RobertA. Ellis -'"
Treatment Plants Director
Cc: Harold. Haywood, :Interim City.Manager
603 LAUCHWOOD DRIVE • P.O. BOX 249 • LAURINBURG, N.C. 28353 • PHONE: [phone] • FAX: [phone]