NC0062383_Other Agency Documents_20220617

Pollution Control System Operator Desi
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NCAC 15A 8G .82111
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Email address: i'4' " 5 ,
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Facility Name:
SUBMIT A S
Facility Grade:
Biological WWTP
Physical/Chemical
Collection System
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FOR EA
Permit #:
E SYSTEM!
?E
Operator in Responsible Charge (ORC)
Print Full Name: Kek,
Certificate Type / Grade ( Number: 61/4) / 1 9 `J S 3 Work Phone #: ( 7
Signature:
Date: 6 4 2- ?
"1 certify that I egreeto my designation as the ()pastor m Itisse le Charge fix the facility noted. l 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."
Back -Up Operator in Re3ponsble Charge (BU ORC) / j
Print Full Name: S .. V e J'1 I ' 1 t" V }`r /
Certificate Type / Grade / Number.
Signature: %1
2 WC
"1 certify that i agree to my a Back-up Operator in Responsible Charge fear the facility noted. I rmdeisamd and will abide by
oaks and regulations pertaining to lbo responsibilities of the HU ORC as set forth in 15A NCAC 08G .0205 and falling to do so am result m
Disciplinary Actions by the Water Pcaution Control System Operators Certification Canted too."
Main fax or aural the
osigiaal to:
Marl or jar a copy to the
apprnpe sue Ar add Office_
Asheville
2090 US Hwy 70
Swam/mom 28778
Far 828 299.71143
Phase: 828_296.458ft
Waslirrstas
943 Washington 5q lti
Washington 27889
FILE 252l411!J215
Phase: 25234E6481
Fgdtenlle
225 Breen St
Suite 714
Fayetteville 28301-5043
Far 918A86.8787
Phase: 91S 433.3388
127 Cadiaal Dr
Wilmington 28405 284
Far 918-338281$
nose: 918.7%.72l5
Fax [phone]