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NORTH CAROLINA
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NC Department of Environmental Quality
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Division of Energy, Mineral and Land Resources
Stormwater Permit Delegation of Signature Authority Form
Directions are in red.
This form shall be used to delegate signature authority from the permit Owner (Permittee) to
another party. Only the Responsible Official defined below may submit permit applications and
reports required by the permit (such as Data Monitoring Reports and Annual Reports) until this
form is completed and submitted to the DEMLR Stormwater Program. Please note that delegating
signature authority does not relieve the Permit Owner from the responsibility for permit
compliance.
=> The permit Owner is the legal entity to which/whom a permit has been issued, and may be an individual
or an organization such as a company or government agency. Every Owner is required to have a
Responsible Official who meets the legal signature authority requirements in 40 CFR 122.22, summarized
below:
• For a corporation, the Responsible Official shall be a president, secretary, treasurer, or vice-
president in charge of a principal business function, or another individual who performs similar
functions for the corporation, or the manager of one or more manufacturing, production, or operating
facilities who is authorized to make management decisions about the facility operation.
• For a partnership or sole proprietorship, the Responsible Official shall be a general partner or the
proprietor, respectively; or
• For a municipality, State, Federal, or other public agency, the Responsible Official shall be either a
principal executive officer [City/County Manager] or ranking elected official (Mayor].
Even if delegated signatory authority has been delegated to another individual, the Responsible Official
retains responsibility for compliance with permit conditions.
Permittee:
CHEP Services, LLC
Permit Number:
NCG210432
Responsible Official Title:
Sr. Director, Operations and Supply Chain
Email Address:
[e-mail]
Phone:
Mailing Address:
5808 Long Creek Park Drive
City:
Charlotte
State:
NC
Zip:
28269
Stormwater Delegation of Signature Authority Form
Page 1

A. Persons to Receive Signatory Authority
==> The signatures of the persons listed below indicates their acceptance of signatory authority.
Delegated Party Name:
Danny Giddings
Delegated Party Title:
Plant Manager
Delegated Party Organization:
CHEF Services, LLC
Email Address:
[e-mail]
I Phone:
980-253-8322
Mailing Address:
5808 Long Creek Park Drive
City:
CWVtte
I State:
NC
I Zip:
28269
Signature of Delegated Party indicating
acceptance of Signatory Authority:
Date:
Delegated Party Name:
Robbie Wilson
Delegated Party Title:
HSE Safety Support Coordinator
Delegated Party Organization:
CHEP Services, LLC
Email Address:
[e-mail]
I Phone:
704-408-2579
Mailing Address:
5808 Long Creek Park Drive
City:
Ch rlotte
State:
NC
I Zip:
28269
Signature of Delegated Party indicatin
acceptance of Signatory Authority:
Date:
Delegated Party Name:
Delegated Party Title:
Delegated Party Organization:
Email Address:
Phone:
Mailing Address:
City:
State:
Zip:
Signature of Delegated Party indicating
acceptance of Signatory Authority:
Date:
Delegated Party Name:
Delegated Party Title:
Delegated Party Organization:
Email Address:
Phone:
Mailing Address:
City:
State:
Zip:
Signature of Delegated Party indicating
acceptance of Signatory Authority:
Date:
Stormwater Permit Delegation of Signatory Authority Form
Page 2

B. Responsible Official Signature
The Responsible Official, as identified in accordance with 40 CFR 122.22, is the appropriate
individual with the authority to sign and submit reports for the organization.
As the Responsible Official, I, Danny Giddings
have the authority to enter into this Agreement for
CHEP Services, LLC
(Owner/Organization Name).
(printed name),
I request that the DEMLR Stormwater Program include the persons listed in Part A of this form
signatory authority for the above -named permit.
I acknowledge that I, and the persons listed in Part A of this form work at/for my organization
and have authority to act as a signatory for purposes of the NCDEQ's electronic document
systems.
By submitting this application, I, Danny Giddings (printed name),
have read, understand, and accept the terms and conditions of the stormwater permit(s) for
which I am the Responsible Official.
Responsibld(pfficial Si
Plant Manage l �/"02C0__-?'
Title Date
Stormwater Permit Delegation of Signatory Authority Form
Page 3

:~ Water Resources
ENVIRONMENTAL QUALITY
State of North Carolina
Department of Environmental Quality
Division of Water Resources
EDMR REGISTRATION FORM
Part A. PERMIT/FACILITY INFORMATION
1. NPDES Permit Number: N I C I G 12 11 I 0 14 13 12
2. Owner/Organization Name: CHEP
3. Facility Name: Chep
4. Facility's Physical Address: 5808 Long Creek Park Drive Suite K
City: Charlotte State: NC Zip Code: 28269
Part B. OWNER USER INFORMATION
1. Responsible Official's Name: Danny Giddings Title: Plant Manager
(Owner or duly authorized representative)
2. Mailing Address: 5808 Long Creek Park Drive Suite K
City: Charlotte State: NC Zip Code: 28269
3. Telephone Number: 980 - 253 - 8322
4. Email Address: [e-mail]
5. User ID (Assigned by NCDWR eDMR Administrator):
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Part C. USER ACCOUNT INFORMATION
1. Facility Administrator Permission
The Facility Administrator user permission can be assigned at the time of registration by the NCDWR
eDMR Administrator. If someone other than the Owner will be responsible for managing facility users
within eDMR and you would like the Division to set up the permission at the time of registration, then
please provide the user details for the individual who will need the Facility Administrator user
permission. Note: If this person will be responsible for submitting eDMR reports, then you will also need
to request Submitter permission for this user.
In addition to the user details, please specify the permit number(s) to which the user will be associated.
If additional space is needed, please make additional copies of the Facility Administrator User Details
and complete as needed.
Facility Administrator User Details
Permit No. (s):
NCG210432
First Name:
Robbie
Middle Name:
Elaine
Last Name:
Wilson
Phone Number:
704 - 408 - 2579
Email:
[e-mail]
User ID:
(Assigned by DWR eDMR Administrator)
NC eDMR Registration Form (Revision 4.1) 1

2. Submitter Permission
Provide the users, in addition to the Owner, who will need Submitter permission. The Submitter user
permission can only be assigned by the NCDWR eDMR Administrator. The Owner specified above will be
given full eDMR permissions including Submitter permission.
In addition to the user details, please specify the permit(s) to which each user will be associated for
eDMR submittal. Should additional space be needed for users and/or permits, please make additional
copies of this page and complete as needed.
NOTE: The Owner will be responsible for creating all facility users except those with Submitter
permissions.
In addition to the Owner and Submitter user groups, there are four user types identified by
user permission level: Facility Administrator, Certifier, Data Entry and View Only.
The Owner and Facility Administrator will have the ability to create and manage facility users.
The Facility User Management Guide, located on the eDMR User Documentation web page,
provides the appropriate procedures for facility user management.
Submitter User Details
Permit No. (s):
NCG210432
First Name:
Robbie
Middle Name:
Elaine
Last Name:
Wilson
Phone Number:-'
704 - 408 - 2579
Email:
[e-mail]
User ID:
(Assigned by DWR eDMR Administrator)
Submitter User Details
Permit No. (s): ,
First Name:
Middle Name:
Last Name:
Phone Number:;r
Email•
User ID:
(Assigned by DWR eDMR Administrator)
NC eDMR Registration Form (Revision 4.1)

RESPONSIBLE OFFICIAL AUTHORIZATION
The Responsible Official, as identified in accordance with Part II, Section 6.11 of the Standard Conditions for
NPDES Permits and 40 CFR 122.22, is the appropriate individual with the authority to sign applications or reports
for the Owner/Organization.
I, Danny Giddings (printed name), have the authority to make this request for Chep (Owner/Organization
Name).
REGISTRATION CERTIFICATION
For the permit(s) associated with the Owner identified above, I request permission to submit DMR data using
the NCDWR eDMR system.
I understand that electronic submittal of the DMR does not fully satisfy US EPA's electronic signature
requirements and as a result, I understand I will be required to print, sign, and submit hardcopies (one signed
original and a copy) of the eDMR to NCDWR under the same reporting requirements as paper -based DMRs as
specified in Part II, Condition D (2) of the NPDES Permit.
I agree to protect the security of my user ID and password from compromise and shall take all necessary steps to
prevent its loss, disclosure, modification, or unauthorized use.
DanLiV Giddings
0 ne /Responsible Official NKme (type or print)
Owner/Respr'onjible Official re
North Carolina General Statute § 143-215.613 provides that:
Plant Manager
Official Title (type or print)
Date
Any person who knowingly makes any false statement, representation, or certification in any application, record, report,
plan, or other document filed or required to be maintained under this Article or a rule implementing this Article; or who
knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case under this Article; or
who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method required to be
operated or maintained under this Article or rules of the Commission implementing this Article, shall be guilty of a Class 2
misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000). 18 U.S.C. Section 1001 provides a
punishment by a fine or imprisonment not more than 5 years, or both, for a similar offense.
NC eDMR Registration Form (Revision 4.1)