NC0073393_ORC_Designation_20220211

WATER POLLUTION CONTROL SYSTEM 0,''P`ERATQR; ESIGNATION FORM
NCAC 15A 8G .0201
Facility Name: DANA HILL COMMUNITY
TAB to Navigate Form
':Hater Quality Reglc;r;
Asheville Remo; .
Permit #
NCO073393
Facility Type: WW Facility Grade: If SUBMITA SEPARATE FORM FOR EACH CLASSIFICATION
Permittee Owner/Officer Name: VITO MONTAPERTO
Email Address:
Permittee Signature:
ail.com
Date: Z 2 2
Full Name: `J MM US (�, uuv SM fffl Work Phone: [phone]
Email Address:
[e-mail]
Certificate Type:
WW__ Certificate Grade: I I Certificate #: 1 10
Signature:
bm Effective Date:
"I certify that I ag a to my designation as the Operator in Responsible Charge for the facility noted. I understand and will
abide by the rules nd 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."
Full Name:
JyTCN I ��5 Work Phone: [phone]
Certificate Type:
WW Certificate Grade: III _ ® Certificate LA 4
Signature:
Effective Date: I Z
"I
certify h t I agree to my designation a Back-up Operator in Responsible Charge for the facility noted. l understand and will
abide by rules and regulations pert "ling 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."
Full Name: __-) 4 �NNON Work Phone: [phone]
Certificate Type: WW Certificate Grade: 11 Certificate #:_1 YJ� 252 6
Signature: Effective Date: `r 1, Z-Z,
"I certify that/ 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."
Mail, fax or email ORIGINAL to: WPCSOCC, 1618 Mail Service Center, Raleigh, NC 27699-1618 I FAX: [phone] [e-mail]
Mail or fax a COPY to: ; Asheville-2090 US Hwy 70, Asheville, NC 287781 FAX: [phone] PH: 828-296 4500
Revised 312019

Facility Name: DANA HILL COMMUNITY Permit #:
NC0073393
Page 2