NC0027103_Signature Authority_20120812

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<August 1, 2012>
Point Source Branch
Surface Water Protection Section
Division of Water Quality
1 617 Mail Service Center
Raleigh, NC 27699-1,617
Subject Delegation of Signature Authority
Town of Pembroke
NPDES No. NC0027103
To Whom It May Concern:
By notice of this letter, I hereby delegate signatory authority to each of the following
individuals for all permit applications, discharge monitoring reports, and other
information relating to the operations at Town of',Pembroke 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.
Oryan Doyle Lowry Town Manner
If you have any questions regarding this letter, please feel free to contact me at (910)521-
9758.
Sincerely,
Oryan .I).
Manager
cc: Fayetteville Regional Office, Surface Water Protection Section
Technical Assistance and Certification Unit

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North Carolina (NC) eDMR Reports
eDMR Registration Form
eDMR is an electronic reporting system, which will provide afacility 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 rior to eD R 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 for registration. If multiple permits are involved, the permit number provided
will be used to identify the Owner and all associated permits. All associated permits issued to the
Owner will be registered for eDMR
Permit Number:
I .
N 1 C I 0 I 0 1 2 I 711 1 01 3 ..I
Facility Owner:
Town of Pembroke
Facility Name:
Pembroke Wastewater Treatment Plant
Facility Address:
P.O. Box 866
Facili City:Pembroke
�'
t-
r
;:
NC
Facility Zip code: '
28372
NC ct)MR Rcgiaratfon Form (RcviBion 3)
Pagel ol4

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Part B: Owner R • a stration - 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 informationprovided for the owner details should
be the official contact person or the person with delegated signatory authority for the Owner.
Last Name:
Lowry
Middle'Name:
Doyle
First Name:
Oryan
Phone Number:
910-521-9758
Email:
[e-mail]
User Id:
(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 pennissions_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 thanthe 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 for will have the ability to manage facility users. The
Facility User Administration Guide will provide the appropriate procedures for facility user
management.
NG cPMR Registration Form (Revision 3)
Psgc 2 of 4

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$tibtttitter user Details' _ _
Permit No. (s):
NC0027103
First Name:
Oryan
Middle Name:
Doyle
Last Name:
Lowry
Phone Number:
91.0-521-9758
Entail:
[e-mail]
User ID:
(Assigned by DWQ eDMR Administrator)
$nbmitter Use- Details
Permit No. (s):
NC0027103
First Name:
Rhonda
Middle Name:
Hagan
Last Name:
Locklear
Pboue Number:
910-521-2989
Email:
rhlocklear(a beilsout1i net
User MI:
(Assigned by DWQ eDMR Administrator)
Submitter User Details
Permit No. (s):
First Name:
Middle Name:
Last Name:
Phone Number:
Email:
User 1D:
(Assigned by DWQ cDMR Administrator)
Sabmitter User. Details
Permit No. (s):
First Name:
Middle Name:
Last Name:
Phone Number:
Email:
Uster,ID:
(Assigned by DWQ eDMR Administrator)
NC cDMR Registration Form (Revision 3)
Page 3 of 4

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Part D: Reiistraiion._Cecation:
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 satin. , 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 IL 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.
Oryari Doyle Lowry Town Manager
Owner (Permit -tee) Name (type or print)
er ' ermittee) Signature
Official Title (type or Print)
07 4., t,.)z_A-q
Date
Please return the completed Registration Form to the NC Division of Water Quality
Fax:
or )Email: or Mail to:
eDMRodmin( ncdenr.gov
NC eDMR Registration Form (Revisim 3)
Information Processing Unit
Attn: eDMR Registration
1617 Mail Service Center
Raleigh, NC 27699-1617
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