430029_Operator Designation Form_20220729

5,��,��)
5 e \-)1,:L1< i ► <z--1 ,ecLL
c z2
L
i t
�r�C�'GLiICs' �- c�PQloa)� e -�11v
D i� t y � i/t 1- ` t v�t1 ! `�' (Nu tz to
tppe
-3 C2 ‹. ovis
�yiJCV L1 r '1i . > 11
J-1
LA -
System Operator Designation Form
7PCSOCC
C 15A 8F .0201
043 _ 29 County: Harnett
ENTERED TO
Jr, Sr, etc.
LASERFJCHE
Work Phone: ( (910 ) 706-3496
Date: 10 March 2022
DWR W «ROS
r the facility noted. I understand an k� i L eErt i% 'da' ' IC
nd failing to do so can result in Disciplinary Actions by the later
9nal)
Jr, Sr, etc.
Work Phone: ( )
Date:
"I certify that I agree to my designation as Back-up Operator in Charge for the facility noted. I understand and will abide by the rules and
regulations pertaining to the responsibilities set forth in 15A NCAC 08F .0203 and failing to do so can result in Disciplinary Actions by the
Water Pollution Control System Operators Certification Commission."
Owner/Permittee Name: William Thomas Butler
Phone #: ( 910 ) 818-1170
Fax#: (910 ) 239-8491
yf� v
Signature: .,t� r� ✓ .,.t.e� �, a tea— E�.-
(Owner or authorized agent)
Date: 07/19/2022
Mail, fax or email the
original to:
Mail or fax a copy to the
appropriate Regional Office:
WPCSOCC, 1618 Mail Service Center,
Email: certadmin(iiincdenr.gov
Asheville
2090 US Hwy 70
Swannanoa 28778
Fax: [phone]
Phone: [phone]
Washington
943 Washington Sq Mall
Washington 27889
Fax: [phone]
Phone: [phone]
Raleigh, NC 27699-1618
Fayetteville
225 Green St
Suite 714
Fayetteville 28301-5043
Fax: [phone]
Phoen: 910.433.3300
Wilmington
127 Cardinal Dr
Wilmington 28405-2845
Fax: [phone]
Phone: [phone]
Fax: [phone]
Mooresville
610 E Center Ave
Suite 301
Mooresville 28115
Fax: [phone]
Phone: [phone]
Winston-Salem
450 W. Hanes Mali Rd
Winston-Salem 27105
Fax: [phone]
Phone: [phone]
Raleigh
3800 Barrett Dr
Raleigh 27609
Fax: [phone]
Phone:[phone]

Animal Waste Management System Operator Designation Form
WPCSOCC
NCAC 15A 8F .0201
Facility/Farm Name: Butler Farms LLC
Permit #: AWS430029 Facility ID#:
043 _ 29 County: Harnett
Operator In Charge (OIC)
Name:Sharron Michelle
Fist
Knight
Cert Type / Number:
Signature:A
Middle
AW A 1011422
ron Michelle
night
Last
Jr, Sr etc.
ENTERED TO
Work Phone: ( [phone]
1 FICHE
Date: 10 March 2022
"I certify that I agree to my designation as the Operator in Charge for the facility noted. I understand and DWR W
pertaining to the responsibilities set forth in ISA NCAC 08F .0203 and failing to do so can result in Disc lina� It
Pollution Control System Operators Certification Commission." P ry Actions y the
ROS.
'LaPIC
ater
Back-up Operator In Charge (Back-up OIC) (Optional)
Name: N/A
First
Cert Type / Number:
Signature:
Middle
Last Jr, Sr, etc.
Work Phone: ( )
Date:
"I certify that I agree to my designation as Back-up Operator in Charge for the facility noted. I understand and will abide by the rules and
regulations pertaining to the responsibilities set forth in 15A NCAC 08F .0203 and failing to do so can result in Disciplinary Actions by the
Water Pollution Control System Operators Certification Commission."
Owner/Permittee Name:
William Thomas Butler
Phone #: ( 910 ) 818-1170
Signature:
(Owner or authorized agent)
Fax#: f q 10 ) 239-8471
Date: 07/19/2022
Mail, fax or entail the
original to:
Mail or fax a copy to the
appropriate Regional Office:
WPCSOCC, 1618 Mail Service Center, Raleigh, NC 27699-1618
Email: certadmin&ncdenr.gov
Asheville
2090 US Hwy 70
Swannanoa 28778
Fax: [phone]
Phone: [phone]
Washington
943 Washington Sq Mall
Washington 27889
Fax: [phone]
Phone: [phone]
Fayetteville
225 Green St
Suite 714
Fayetteville 28301-5043
Fax: [phone]
Phoen: 910.433.3300
Wilmington
127 Cardinal Dr
Wilmington 28405-284.5
Fax: [phone]
Phone: [phone]
Mooresville
610 E Center Ave
Suite 301
Mooresville 28115
Fax: [phone]
Phone: [phone]
Fax: [phone]
Winston-Salem
450 W. Hanes Mall Rd
Winston-Salem 27105
Fax: [phone]
Phone: [phone]
Raleigh
3800 Ban-ett Dr
Raleigh 27609
Fax: [phone]
Phone:[phone]