NC0071005_ORC Designation_20220211

WATER POLLUTION CONTROL SYSTEM OPERATOR DESIGNATION FOO-
NCAC 15A 8G .0201
TAB to Novigote Form Water Quality Regiof-,6
Facility Name: LYNNBROOK HOMEOWNERS ASSOCIATION Asheville Region
Permit # NCO071005
Facilit T e:--- — _
Y YP WW Facility Grade: i! SUBMITASEPARATEFORM FOR uACHCLASS/FICATION
Permittee Owner/Officer Name: JOAN BECK
Email Address: }beGc{g�paj�,�gln
Permittee Signature: �c,►-�
Date: _ 12
Full Name
Email Addi
Certificate Type:
Signature:
WW.— Certificate Grade: I I 0
Certificate #: 10 1 ` 3-4
• Effective Date:
"l certify that l agre o my designation as the Operator in Responsible Charge for the facility noted. l understand and will
abide by the rules a 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: \y TAN liT \ 3kM1F�S Work Phone: [phone]
Certificate Type: WW Certificate Grade: I i 4 0 -19
Certificate #:_
Signature: Effective Date:
Z-1- -
"l ce i y h l agree to my designation as Back-up Operator in Responsible Charge for the facility noted. l understand and will
abide by t rules and regulations pertaini g 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: `li�N NONy M`EZ7) Work Phone: [phone]
Certificate Type: WW 0
-_ Certificate Grade: I I Certificate #: 0 Z S Zb
Signature:
Effective Date:
"I certi}y7 at I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. /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 1 FAX: [phone] [e-mail]
Mail or fax a COPY to: ;Asheville-2090 US Hwy 70, Asheville, NC 28778 1 FAX: [phone] PH: 828-296 4500
- -
Revised 3120>9

Facility Name: LYNNBROOK HOMEOWNERS ASSOCIATION Permit #:
NCO071005
Page 2
Full Name: Davis James Work Phone: [phone]
Certificate Type: WW Certificate Grade: II Certificate #: 997463
Signature: Effective Date: 2- I r 2 L
"I certify that I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. l 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."
Full Name: Work Phone:
Certificate Type: Select Certificate Grade: Select Certificate #:
Signature: Effective Date:
"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."
Full Name: Work Phone:
Certificate Type: Select Certificate Grade: Select Certificate #:
Signature: Effective Date:
"1 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."
Full Name: Work Phone:
Certificate Type: Select Certificate Grade: Select Certificate #:
Signature: Effective Date:
"1 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."