NC0036269_Other Agency Documents_20220505

WOROS
MOORESVILLE RE3IONAL OFFICE NC0036269
Facility Name: Rocky River egiona Wastewater Treatment Plant Permit #
Facility Type: WW El Facility Grade: Iv © SUBMITA SEPARATE FORM FOR EACH CLASSIFICATION
Permittee Owner/Officer Name: Travis Mark Fowler
Email Address:
mfowler@wsacc.o
Permittee Signature: 1`s= �` - ��c-✓
Full Name:
Email Address:
James Christian Sims
[e-mail]
Certificate Type WW
Signature:
Full Name:
Work Phone:
[phone]
Certificate Grade: IV Certificate #: 999309
Effective Date: l 2 2_
"I cer y that I agree to my designation as the Operator in Responsible Charge for the facility noted. I understand and will
abi e 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."
Backup ORC
Karen Renee Marie
Certificate Type: WW Certificate Grade: IV
Signature:
Full Name:
Work Phone: [phone]
Certificate #: 1002612
Effective Date: 9-2 e-ZZ-
"1 certify that 1 agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. 1 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."
Braden Joshua Cook
Certificate T •e:• WW
Work Phone: [phone]
Signature:
Effective Date: • a H • ��i
"I certi t t I agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. 1 understand and will
• .,,,.+ni.,inn to the recnnncihilitiec of the ORC as set forth in 15A NCAC 08G .0204 and failing to do

Facility Name: Rocky River Regional Wastewater Treatment Plant Permit #:
NUUUUbLOJ
Full Name:
Certificate Type: WW LJ
Signature:
Full Name:
Certificate Type: WW
Signature:
Nicholas James Merwin
Certificate Grade: IV
Work Phone:
Certificate #:
Effective Date:
"I ce that I 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
er Pollptbn C'o'n'es of trol Syste em � Operators CeRC as set rtification CommissionG ."
and failing to
do so can result in Disciplinary Actions by t
[phone]
1006823
Backup ORC
Kevin Morgan Graves
Certificate Grade: IV
Work Phone:
Certificate #:
788-4164
999374
Effective Date: LJ • 2; • 2A:a
"I ce ify that I agre t 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 Wateer Pol �tionbClon'es of the trol System Operators CeRC as set rtification Commission.G "
and failing to
do so can result in Disciplinary Actions by h
Backup
Backup ORC
Full Name: Jesse Lee Wingler
Certificate Type: WW Certificate Grade: IV
Signature:
Full Name:
Certificate Type: WW
Work Phone:
Certificate #:
704) 788-4164
1004838
Effective Date: ' PS -92
y noted. I
tand
will
certify that 1 agree t my designation as a Back-up Operator eof the ORe C as set forth in 15Arge for the tNCAC 08G 0204sand failing 1 �g to
abide by the rules and regulations pertaining toresponsibilities
do so can result in Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Backup ORC
Oriss Wayne Cross
Certificate Grayie:
J
IV
Work Phone:
Certificate #:
1010733

Facility Name: Rocky River Regional Wastewater Treatment Plant Permit, ft.
Backup ORC
Full Name:
Certificate Type: WW---
Effective Date: Y- Zl-
----- or the facility noted. 1 understand and will
Operator in Responsible Charge f failing to
that I agree to my designation as a Back-up p
1 certify 'ons pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and f 9
abide by
the result in Disciplinary
regulate p the Water Pollution Control System Operators Certification Commission."
do so can in Disciplinary Actions by
Work Phone:
Certificate #:
[phone]
1002601
Signature:
Full Name:
Certificate Type: WW
Nathaniel Ryan Hargrove
Certificate Grade: IV
Signature:
Adam Neal LpVe
Backup ORC.
Certificate Grade: IV
Work Phone:
Certificate #:
704) 7884'64
1009200
Effective Date: 5' „,'
Responsible Charge for the facility noted. i understand and will
Operator in Resp forth in 15A NCAC I understand
and failing to
aide by that l agree ando g latio designation t as a Back-up P
pertaining to the responsibilities of the ORC as set f
the rules regulations p Operators Certification Commission."
doiso bythe Water Pollution Control System Op
so can result in Disciplinary Actions by
Full Name: __.----- --
Certificate Type: SeieCt [�
Signature:
Backup ORC
Certificate Grade: Select__
Work Phone:
Certificate #:
Effective Date:
Responsible Charge for the facility noted. 1 understand and will
designation as a Back-up Operator in Resp forth in 15A NCAC I understand
4 and failing
"1 certify that I agree ando my pertaining to the responsibilities of the ORC as set f
the rules regulations p Operators Certification Commission."
doide bythe Water Pollution Control System Op
so can result in Disciplinary Actions by
Full Name:
Certificate Type: select_ 1I
Backup ORC
Certificate Grade: Select
lj
Work Phone:
Certificate #: