NC0087122_ORC Designation_20220211

WATER POLLUTION CONTROL SYSTEM OPERATOR
A11twN,
PON FORm FEB 1202Z
NCAC 15A 86.0201
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Facility Name: COOPER RfiS
Facility Type: WW Fa011ry Grade: 11
Permiftee Owner/Ofircer Name:
Email Address:
Permittee Signature:
iNater Q Jality Regional Operatiorn!,
Asheville Regional OfficE-
Permit It NC-0087122
SUBMITAiSUARATE Ft;RM FOR £ACH
Date: -L 1 ' Z`Z
Full Name: 3+\M US & LIM SM 11AA Work Phone: [phone]
Email Address: [e-mail]
Certificate Type: WW Certificate Grade: I Certificate #:
Signature: OM
Effective Date:
"I certify that l ree to my designation as the Opera or in Responsible Charge for the facility noted. I understand and will
abide by the rul 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."
Full Name: V_w M ` � � WES Work Phone: [phone]
Certificate Type:
Signature
WW _ Certi 'cate Grade: ` Certificate #:
Effective Date:
"I certi hat I agr�ede to my e n as a Back-up Operator in Responsible Charge for the facility noted. 1 understand and will
abide the rules and regulations p rtaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to
do so c n result in Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Full Name: S"NN t-101A ')w E's Work Phone: [phone]
Certificate Type: WW Certificate Grade: I Certificate #: ) A0 Z_'J 2r 6
Signature: Effective Date:
"l 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 asset 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 1 FAX: 919-71S-2726 I [e-mail]
Mail or fax a COPY to: ; Asheville-2090 US Hwy 70, Asheville, NC 287781 FAX: 828_299-7043 1 PH: 828-2964500 _
Revised 312019

Facility Name: COOPER RIIS
Permit M NCO087122
Page 2
Full Name: Davis James Work Phone: [phone]
Certificate Type: WW Certificate Grade: II Certificate #: 997463
Signature:
`P Effective Date: 2-1-12
"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."