NC0086550_ORC Designation Form_20070529

Jan 29 09 08:40a
Town OE Fairmont
6289879
p.2
Water Pollution Control System Designation Form
wPcsocc
NCAC 15A:08G .0201
General Information:
Permittee Owner/Officer Name: Town of Fairmont/H. Blake Proctor
Mailing Address: Post Office Box 248
City: Fairmont
Telephone Nwnber: 910 68-9766
Signatu
State: NC Zip: 28340
Facility information:
Facility. Town of Fairmont WWTP
Permit Number. W000300261
County: Robeson
! SUBMIT A SEPARATE FORM FOR EACII TYPE OF SYSTEM !
Mark (X) Type of Facility Class 0 — 4)
Spray Irrigation N/A
Wastewater Plant Land Application X N/A
Physical/Chemical Subsurface N/A
Collection System
Class
Operator in Responsible Charge:
Print Name: _Eric Norman Thomason
Certificate Type and Grade: LA
Work Telephone: 036 ) 971-9085
Social Security # : 243-23-0902
Certificate #: 29096
Signature: 4. i
Back -Up Operator in Responsible Charge:
Print Nance: Todd Eugene Sheariri
Certificate Type and Grade: LA
Work Telephone: ( 336 ) 998-7150 _ Signature:
Mail or Fax to:
WPCSOCC
1638 Mail Service Center
Raleigh, N.C. 27699-1613
Fax: [phone]
Social Security # : _244-23-4383
Certificate #: 987969
Revised 10/2000

Jan 29 09 08:41a Town OE Fairmont
6289879 p.3
• SYNAGRO
A Residuals Management Company
July 12, 2007
Blake Proctor, Town Manager
Town of Fairmont
P. O. Box 248
Fairmont, NC 28340
RE: Biosolids Management Service Agreement
Dear Mr. Proctor:
Enclosed please find two (2) original sets of documents containing the Agreement,
Certificate of Insurance, and Form W-9 for the referenced contract. The documents that
were previously sent for your signature used an old agreement form and some of the
indemnification language was missing. We ask that you discard any copies that you
have on file and retain a copy of this corrected agreement in its place.
Please sign both originals of the agreement, retain one original for your records and
return the other original to my attention at the address below for our records.
Should you have any questions or need further information regarding this agreement,
please feel free to contact me at [phone] or sgregorvCcdsvnaqro.com. We thank
you for this opportunity and look forward to working with the Town of Fairmont on this
project.
Sincerely,
SYNAGRO CENTRAL, LLC
Sue A. Gregory
Legal Manager
Encfosures
1300 Bering Drive, Suite 1000 • Houston, TX 77057 • Ph: [phone] • Fax: [phone] • To11 Free: [phone]

Jan 29 09 08:41a Town OE Fairmont
6289879 p.4
SYNAGBO
A Residuals Management Company
May 25, 2007
MEMORANDUM
TO: H. Blake Proctor, Town M ger, Town of Fairmont
FROM: Eric Thompson
RE: ORC for Land Application of Residuals permit (#WQ00300261)
/1;:\
, o)11:
Enclosed please find the WPCSOCC's form to designate the land application ORC and
Back-up ORC for your facility. Due to your new land application, we need to provide this
information to the state.
The permittee's signature is required on this form. Please return the form to me in the
enclosed envelope. You may also want to make a copy for your records.
If you have any questions, please call me at 336-971-9085 or contact me via e-mail at
ehompson a,synagro.com.
Thanks,
..,//
284 Boger Road • Mocksvillc, NC 27028-7619 • Ph: [phone] • Fax: [phone] • Toll Free: (877) 267-26a.

Jan 2.9 09 08:40a Town OE Fairmont
6289879
p.1
TOWN OF FAIRMONT PUBLIC WORKS
P.O. BOX 248
FAIRMONT, N.G. 28340
910628-0064
FAX [phone]
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