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Home My WebLink About740039_Owner (Affiliation Change)_2018091710/16/2018 12:42PM FAX 2523641902 Coffin Dykes litoQoilooai Animal Waste Management System Operator Designation Form Wpc_socc NCAC 1SA SE.0201 Facility/Farm Name: High Ridge Farm Permit k: _ AWGI 0000 _ . Facility Mg: 74 - 39 County. Pitt Operator In Charge (OIC). Name: Colin First John Mot fr Dykes Tao Jr. Sr, etc. Cert Type J Number: AWA999138 Work Phone: (_252 ) 717-2321 Signature: Date: 09/07/2018 "I certify that 1 agree to my design anon as the Operator in Chime for the facility noted. l understand and will abide by the rules and rep' talons pertaining to the responsibilities set forth in l5A NC AC 08F .0203 and failing to do so can result in Disciplinary: Actions by the Water Pollution Control System Operators Certification Comunissiotl." Back-up Operator in Charge (Sack -up OIC) (Optional) Name: William Fiat Cer1'I"ype J Number: Signature: Hickman La! Eugene Middle AWA987745 Jr Jr. Sr, etc. Work Phone; ( 252 ) 341-2435 Dale: 0910712416 "1 certify that 1 agree to my designation as Back-up Ope r in Charge for the facility noted. I understand and will abide by the noes and regulations pr:rtuining to the respumibilities set forth in 15A IICAC 08F .0203 and failing to do so can result in Disciplinary Actions by the Water Pollution Control System Operators Certification Commission." Owner/Perwittee Name: _ Stephen B Coles Phone #:. 910) 879-8666 Fax#: ( 252) 758-0890 Signalure: [Owner or nu0Lorixcd egcny Malt, fax or email the original 1o; }full or fax a copy ro the appropriate Regional Office: lccvracd 4OIS Dale: 09/0712018 WPCsOCC, 1618 M11ail Servlee Center, Raleigh, NC 27699.161 g Email: cerisdmint r tlenr.p0v Asheville 2090 US Hwy 70 Swanmanaa 2871S Fax; 828,299,7043 Fhont i 828.296.4500 WaNhingtvn 943 Washington Sq Ma11 Washington 27889 Fax. 152.946.9215 Phone:252.946.64Si Fayetteville 225 Green St Suite 714 Faysttevillc 28301-5043 Fax; 910.486.0707 It bolo: 910.433.33110 Wilmington 127 Cardinal Dr Wilmington 28405-2845 Fax: 910.350.20U4 Phone'', 910.796.7215 Fax: 919.715,2726 Mooresville 610 E Center Ave Suite 301 Mooresville 28115 Fax: 704.663.6040 Phone: 704.663,1699 Winston-Salem 450 W, Harass Mall Rd Wiostan-Salem 27105 Fax: 336.776.9797 Plione: 336,776,9E00 (Retain a ropy of this form for your records) Raleigh 3800 Barrett i`Jr Raleigh 27609 Fax: 919.571.471 a Phone_919,791.42I)0