NC0043176_ORC Designation Form_20010606

06/08/2001 08:51. - 9108974561
DUNN WATER PLANT.
I '
PAGE 01
Facsimile Transmittal
City ofDunn Filter Plant
[phone]
Fair [phone]
Post Office Box 1065
Dean, No th Carolina 29335
Date: June 8, 2001
Attention: Belinda Hanson
From: Joe Campbell
Number of pages (including this cover): 2 !i"
c _
Comment(s): Here is the information
ti
I
that you requested in reference
Inspection. Thanks, Joe Campbell
to our last
I
I,
I
Reply requested: 0 Yes 0 No I'

06708/2001 08: 51 9108974561
06/05/2e01 09:47 S19-733-133E(
DUNN WATER PL4NT:1
", DEHR WATER I2U4_4
PAGE 02
PAGE 02/02
Water Pollution Control System Designation Form
WPCSOCC
NCAC 15A:08G .0201
I
General Information:
e
Permittee OwnetiOfficer Name: Ci4/ 0-€ — 1.
Mailing Address; I 0 c.
C
City: --Du rt la State:_- Zip: 3 5-
Telephone NL umber: aj°)17=gj
Signature:
-2419( `i 1/44J-L Date
• pp..am,
Facility Infornmion:
rz\
Facility: ladx- Rs. 4re %, CO4Sie.wed-C-e- "Tatievi.614- tj12. +-
Permit Number: file DO Sig / 4 County: Ntu-4t et
SUBMIT A SEPARATE FORM FOR EACH TYPE OF SYSTEM!
Matt (X) Type of Facilit law (I 4).
Wastewater Plant
Physical/Chemical
Collection System
Spray Irr4ation
Land Application
Subsurface
•
in Responsible Charge:
Print Name: -80 E.
Social Security : 2 2 - o S-
Certificate Type and Grade: 4.401d7; 4262.777 e 1--g- Certificate #. e 0 3 2
1 .
d+ '
1 . ' ,
D 1011 ISMi DD I m sakfailloospossiiiv
-
Back -Up Operator in Responsible Charge:
Print Narneldsept,_ 'T .,xpisli Social Security ii : Z 401Z -29,4 a- lei
Certificate Type and Grade: J1L -14141 Certificate #: di t-113
Work Telephone: -(4/4, ) ' 7-.:1
, --12.41 Signature:
-
Wo'ric Telephone: (9/0 )2-j5S signature:
Mail 0 Faxto: WPCSOCC
I
1618 Mail Service Center
Raleigh, N.C. 27699-1618
Fax: [phone]
Retsed10/2000
b 11