NC0025836_ORC Designation Form_20220101

WATER POLLUTION CONTROL SYSTEM OPERATOR DESIGNATION FORM
NCAC 15A 8C .0201
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Facility Name: HOT SPRINGS WWTP Permit # NCO025836
Facility Type:: WW Facility Grade: 11 SUBMITA SEPARATE FORM FOR EACH CLASSIFICATION
Permittee Owner/Officer Name: ABIGAIL NORTON
Email Address: [e-mail]
Signature: Effective. Date:
"l certify that I agree to my designation as a Back -tip 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 086.0204 and failing to do
so con result in Disciplinary Actions by the Water Pollution Control System Operotnrs c a r
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Mail, fax or email ORIGINAL to; WpCSOCC, 1618 Mail Service Center, Raleigh, NC 27699-1618 (FA7t: 91U-715-2726 Icertadmlrs@nt� r g
Mail or fax a COPYto: Asheville-2090 US Hwv 70, Asheville, NC 28778 FAX. [phone] i PH: 828-296-4500
Water (duality Regional Opera" o 'fy
Asheville Regional Office

fI%J/AGi/C 0!011
Signature: Signature: _--
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Email: [e-mail] Email: [e-mail]