NC0004979_ORC Designation Form_20221121

WATER POLLUTION CONTROL SYSTEM OPERATOR DESIGNATION FOR
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NCAC 15A 8G .0201 s'^^
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TAB to Navigate Form
Facility Name: Plant Allen Steam Station
Facility Type: PC 0
Permit # NC0004979
Facility Grade: II E SUBMIT A SEPARATE FORM FOR EACH CLASSIFICATION
di. N
Permittee Owner/Officer Name: Jeffrey Flanagan
Email Address:
[e-mail]
Permittee Signature:
Full Name: Joshua Layne Calhoun
Email Address.
[e-mail]
Certificate Type- PC
Signature:
Full Name:
Certificate Grade:
I I
L. /v - Effective Date: ` , .-� 1.- y
"I cer y that I agree esi ationas the Operator in Responsible Charge for the facility noted. l understand and will
abi yy 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."
VVQRS
i(i!IOOHESVILLE REGIONAL_ OFFICE
Work Phone:
[phone]
Certificate #: 1012355
Backup ORC.
Michael R Gantt
Certificate Type: PC
Signature:
Full Name:
Certificate Grade: II
Work Phone: [phone]
Certificate #: 1004850
Effective Date: /L / / yt)
"1 certify that / 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 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."
Certificate Type: Select
Signature:
Certificate Grade: Select
Work Phone:
Certificate #:
Effective Date:
"1 certify that 1 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 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."
Mail, fax or email ORIGINAL to: WPCSOCC, 1618 Mail Service Center, Raleigh, NC 27699-1618 I FAX: [phone] I [e-mail]
Mail or fax a COPY to: Mooresville-610 E. Center Ave., Suite 301, Mooresville, NC 28115 I FAX: [phone] I PH: 704-663-1699
Revised 3/2019

WATER POLLUTION CONTROL SYSTEM OPERATOR DESIGNATION FOR
NCAC 15A 8G .0201
TAB to Navigate Form
Facility Name: Plant Allen Steam Station
Permit #
fl
NC0004979
Facility Type: WW Facility Grade: II 0 SUBMIT A SEPARATE FORM FOR:`ACHFCLASSS1FJO 01VR
Permittee Owner/Officer Name: Jeffrey Flanagan
Email Address:
NOV 2 1 2022
[e-mail]
Permittee Signature:
Full Name: Joshua Layne Calhoun
Email Address.
ORC
Operator in Responsible Charge
[e-mail]
Certificate Type WW 0
Signature:
Certificate Grade:
I I
er � crr ; -- IV— 4 ,2v�,u..Effective Date: 1,l-, ---/ .., . _,
"1 certify t i t l agree to my esign ion as the Operator in Responsible Charge for the facility noted. I understand and will
abide by e rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and
failing t do so can result in Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Date:
Work Phone:
VVQROS
MOORESVILLE REGIONAL. OFFICE
I,lZ120zz
[phone]
Certificate #: 991323
Backup ORC
Full Name:
Michael R Gantt Work Phone: [phone]
Certificate Type: \NW 0 Certificate Grade: II 0
Signature:
Certificate #:
5969
Effective Date: / L (/ /
"I certify 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 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
Full Name:
Certificate Type: Select
Signature:
Certificate Grade: Select
Work Phone:
Certificate #:
Effective Date:
"I certify 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 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."
Mail, fax or email ORIGINAL to: WPCSOCC, 1618 Mail Service Center, Raleigh, NC 27699-1618 I FAX: [phone] I [e-mail]
Mail or fax a COPY to: Mooresville-610 E. Center Ave., Suite 301, Mooresville, NC 28115 I FAX: [phone] PH: 704-663-1699
Revised 3/2019