NC0082970_Signature Authority_20230510

May 5, 2023
Wastewater Branch RECEIVED
Water Quality Permitting Section MdaY 11 2023
Division of Water Resources
1617 Mail Service Center �pE�I®W��P®
Raleigh,NC 27699-1617
ES
Subject: Delegation of Signature Authority
CTI OF NORTH CAROLINA, INC.
NPDES Permit Number NC0082970
To Whom It May Concern:
By notice of this letter, I hereby delegate signatory authority to each of the following individuals for all
permit applications,discharge monitoring reports, and other information relating to the operations at
the subject facility as required by all applicable federal, state, and local environmental agencies
specifically with the requirements for signatory authority as specified in 15A NCAC 2B.0506.
Individual #1 Individual#2 (if applicable)
Name: Rebecca Long
Title: Chemist
Mailing Address: 1002 S Front Street
Wilmington,NC 28401
Physical-Address:
(if different)
Email Address: [e-mail]
colonialterminals.com
Office Phone: 910 - 762 - 2271 - -
Mobile Phone: 910 - 512 - 2350 - -
If you have any questions regarding this letter,please feel free to contact me at
[e-mail] or 910.762.6615.
Since -ly, INK r
401.reg iv
mi,...011,4
Philip Watts
Terminal Manager
1002 S Front St,Wilmington,NC 28401
Pwatts@Co Toni alteiminals.com
910.762.6615
904.228.8051
cc: Wilmington Regional Office,Water Quality Permitting Section

N.C. Department of Environmental Quality
Division of Water Resources
Electronic Signature Agreement
Federal regulations require that electronic documents must have valid electronic signatures if Title 40 of
the Code of Federal Regulations requires handwritten signatures on the paper documents they replace.
Valid electronic signature refers to an electronic signature on an electronic document that has been
created with an electronic signature credential.
This Electronic Signature Agreement,when finalized and approved,will allow the individuals with
electronic signature credentials to sign electronically a variety of required permit documents in lieu of the
submittal of signed paper copies. The submittal of Electronic Discharge Monitoring Reports (eDMR)
will be available once your electronic signature credentials are in place. Some agreements for document
submittals or acceptance, as noted in the Agreement Conditions(Section B.), are not currently available
electronically but are included here to have the agreements in place and to avoid the need to complete
future submittal of agreement forms when these systems are initiated.
A. Owner/Organization Information
Owner/Organization Name: ('r(� e� NOv Caaro ar,AA �1c•
Responsible Official: ^
(as identified in accordance with 40 CFR 122.22) T'1 Iti P " S
Street Address: I t5D Fror.'(
City: d l!n i ft5+1 °1
State/Zip: MC , a-554c
Phone Number: - (`UD )1 tc - &a1
Email Address:
*email will be the primary method of contact for the`electronic e c,, 0,_- t cQ ie.r,„j ywi5.(o ff
submittal process so it is important to have an accurate email
available at all times
B. Agreement Conditions
To receive and accept the required electronic signature credential, consisting of a user name and
password,issued by the North Carolina Division of Water Resources (NCDWR)in order to sign
electronic documents submitted to NCDWR's Electronic Document Systems and to receive electronic
documents from NCDWR's systems;
The Responsible Official and Submitter(if applicable)named in this form do herby:
1. Understand that this Electronic Signature Agreement requires me to submit electronic documents to
NCDWR's approved eDMR system under the authorized program in lieu of paper submissions.
2. Understand that this Electronic Signature Agreement requires me to accept electronic transmissions,
in lieu of paper transmissions of all permits,permit modifications, authorizations to construct,and
any other correspondence related to reviewing and processing permits from NCDWR. This
authorization will not become effective until NCDWR establishes a system for processing electronic
documents; I am notified in writing from NCDWR that use of the electronic systems has officially
been initiated; and North Carolina rules and statutes are changed to allow the implementation of
electronic submittal and acceptance of documents.
NCDWR Electronic Submittal Agreement Version 1 Page 1

14. Agree to report,within 24 hours of discovery, any evidence of discrepancy between any electronic
document I have signed and submitted and what the NCDWR eDMR has received from me by
contacting the NCDWR eDMR Administrator via email at eDMRadminc ncdent-.gov.
15. Understand that the NCDWR eDMR's system will automatically reject any electronic document
submitted without a valid electronic signature if such signature is required.
16. Agree to contact the NCDWR eDMR Administrator via email at [e-mail] within
ten working days if my duties change and I no longer need to interact with eDMR on behalf of my
organization.
17. Agree to notify the NCDWR eDMR Administrator via email at [e-mail] if I cease
to represent the regulated entity specified above as signatory of that organization's electronic
submissions as soon as this change in relationship occurs.
18. Understand that the NCDWR may contact the Organization's Responsible Official,who signs below
to authorize me as a signatory for the Owner/Organization,in order to verify my identity.
19. Agree to retain a copy of this signed agreement as long as I continue to represent the regulated entity
specified above as signatory of the Organization's electronic submissions.
20. Certify that I have the authority to enter into this Agreement on behalf of the Organization identified
above,and I am a signatory authorized to represent that Organization, and I am able to sign and
submit reports and other information on behalf of that Organization in the capacity required by statute
and/or regulation.
C. Permit/Facility Information
Approval under this Electronic Signature Agreement is applicable to the following permits and if
applicable to the Submitters, if noted here and in Section E:
Permit
Number' Facility Name Facility Address Submitter2(if applicable)
N►C,00 91b Nuc6 ars kre, tc b S Ern4 sFyee ebe c c. Lan
1. You may only include permits associated with One owner. If more space is needed for additional permits or submitters you
may attach separate pages. A supplemental sheet is available at:https://deq.nc.gov/about/divisions/water-
resources/edmr/fonus-and-reports
2. A separate Section E must be included for each Submitter in order to obtain a hard copy signature and notarization for all
entities. If more than one individual will have submitter permissions for the same permit,then indicate this on separate
rows.
NCDWR Electronic Submittal Agreement Version 1 Page 3

D. 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.
I, 72hi/i p W 5 (printed name),have the authority to enter into this
Agreement fok• v4 (yokk Cc rb1ling) one• (Owner/Organization Name).
I request the NCDWR grant me and,if included in Sections C and E of this form,the named Submitter(s),
an electronic signature credential to submit and accept documents electronically on behalf of my
organization.
I acknowledge that I, and the individual(s)named in Sections C and E(if applicable),work at/for my
organization and have authority to submit and accept electronic documents and act as a signatory for
purposes of the NCDWR's electronic document systems.
By submitting this application,I, 1/ I, t..,),/,‘ (printed name),have read,
understand, and accept the terms and conditicins of this Electronic Signature Agreement. I certify under
penalty of law that I have personally examined and am familiar with the information submitted in this
application and all attachments and that,based on my inquiry of those persons immediately responsible
for obtaining the information contained in the application,I believe that the information is true, accurate
and complete. I am aware that there are significant penalties for submitting false information,including
the possibility o fine and imprisonment.
Responsibl :Official Signature Title Date
000,140 cokyzaidi ,5-tom- 4/49 - 951- ioZD
Email address Phone Number
*email will be the primary method of contact for the electronic submittal process so it is important to have an accurate email
available at all times
If you are a current eDMR submitter please provide your User Id:
User Id
Subscribed and sworn to before me this j.,0 day of A , 2002 .
Signature of Notary Public
Printed Name of Notary Public
My Commission Expires: 4 f l
(SEAL)
NCDWR Electronic Submittal Agreement Version 1 Page 4

E. Submitter Signature
The Submitter(electronic signature applicant)is a user other than the Responsible Official who submits
this agreement to request to sign reports electronically. The Submitter is given signatory authority by an
individual identified as the Responsible Official by the Owner/Organization to sign reports and other
information and to accept electronic documents.
I, e)� L (printed name), am authorized by the Responsible Official
name in this document,who dd's have the authority under the applicable standards,to enter into this
agreement for CIS- G iJ0 CCe-Y Wry . (Owner/Organization Name).
By submitting this application,I, ` ^ (printed name),have read,
understand, and accept the terms anfQie&t
conditions of this Electroc Signature Agreement. I certify under
penalty of law that I have personally examined and am familiar with the information submitted in this
application and all attachments and that,based on my inquiry of those persons immediately responsible
for obtaining the information contained in the application,I believe that the information is true, accurate
and complete. I am aware that there are significant penalties for submitting false information, including
the possibility of fine and imprisonment.
R.(1)Q.&&, AYr GMT s St )z I2,3
Submitter Signature Title Date
r'-C 6 rtcj P �f,�f1•.10- it ha,ts.ti.,f+n 61�0-1(Q)--� - qt\
Email Addr6ss Phone Number
*email will be the primary method of contact for the electronic submittal process so it is important to have an accurate email
available at all times
If you are a current eDMR submitter please provide your User Id:
User Id
ni
Subscribed and sworn to before me this,- day of rfl , 20 3 .
op, Posiv.)&11._
Signature of tary Public
X&4h . '3`,1
Printed Nafne of Notary Public
My Commission Expires: 12) c 1 ab a(o
(SEAL)
NCDWR Electronic Submittal Agreement Version 1 Page 5