WQ0000957_ORC Designation_20181019

WATER POLLUTION CONTROL SYSTEM OPERATOR DESIGNATION FORM:(WPCS000).
NCAC iSA 8G A201
Press TAR to enter Information
Per mittee 0wggr1offlcer-Na6e: Valley. Proteins, Inc::Robert.T: Vogler, Director.of Environmental Affairs -
Malling-Address: P.O:Box-3588 Piionei
City: Wlndhe'iter .: State:. VA zlp; 22604
Email Address: by [e-mail]:
Signature:
`''� Dater
Facility Name: Valley Proteins -� Wadesboro.WWTF Permit q W00000987
county: Anson
YOU MUST SUBMIT A $EPARATEIFORM FORM TYPE AND CLASSIFICATION OF SYSTEM:
OPERATOR IN.RESPONSIBLE.CHARGE ORC .
Print Full Name: James Hodges I Work Phone: 704418=49.12
Certificate Type: SrI Certlficate.Gradea Select. Certificate Ia:.18564
Email Address: [e-mail],
-Signatures _Date:
`: ;i 1, certljy that I opreeao rr: eslgnation os the Operator in R ponsible Charge jar the Jacillty noted. ! understan and wHl abide by the
Ii rules and regulations p wining to the, responsibilities of the 0RC as iet forth In 1SA:NCAC O8G_.0204 and falling to do so can result. in
i Discip inory Acdons_by a Water Pollution Control System Operators C007cation Commission."
ii
If
l:
I BACKUP ORC
{ ' Jonathan Kirby
Print Full Name:: Y I � - .. � Work Phone:.[phone]
, ,Certificate Type- $I I Certificete-Grade ,Select: Certificate #; 997303
Small Address: jkirby@v eyp oteins.com
. Signature: m�1
!; a' ` . Date:.
1, certify that !ogre . to my designatian as o Sack -up Operator In Responslbie.Charge for.the faculty noted. l understand and will abide by
,',the rules and regulations pertaining to ithe responsibilities of the ORC as set forth in ISA NCAC 08G :0204 and failing to do ao can result. in
01sclplinory Actions by the Water PoilutionControlSystem Operatorr.Cerdflcotion Commission."
: ,!,iMalI, fax or-enia1I..': • WPCSOCC,16lalmd1l Service. Center, .... Fax: 910-71S-2726 Email: certadmin�?ncdenr;gav
9RIGINAI to: Raleigh, NC 27699.1618
;Mail or Fax -Asheville Fayetteville Mooresville Raleigh
:a;CoPY to: .2090 us Hwy 70 225 Green St., Suite 714: - 610 E. Center Ave., Suite 301 3800 Barrett Or.
Swannanoa, NC 28778 Fayettevlile, NC 18301-5043 Mooresville, NC 28115 Raleigh, NC 27669.
Fax:[phone]: Fax:910=486.07.07 Fax:[phone]' Fax:[phone]
Phone:828-'296-4500 - Phone.[phone] Phone.[phone] Phone:[phone]
-
r: Washington Wilmington Winston-Salem
943 Washington Sq. Mall .127, Cardlnal:Dr, 45 W. Hanes Mall Rd,
Washington, NC27889, -Wilmington; NC 28405-2845 Winston-Salem, NC 27205 . .
i Fax:[phone] "Fax:[phone] Fax:[phone]
Phone:252.946�6481 Phone:[phone] Phone, 336476-9800
f, Revised Q016
_ All
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All' ;
Facility
Type:
Sl
Fadh 'Grade:, :.
N!C- .

WATER POLLUTION CONTROL SYSTEM OPERATOR- DESIGNATION F.ORM:(WPCS000)
NCAC 15A BG -.6201
Press -TAB to enter Information .
Permittee owner/officer Name: Valley Proteins,. Inc. Robert T: Vogler, Director of Environmental Affairs
Mailing Address: P,.O..Box.3588." Phone: --
City: Winchester Stafe::. VA , . :Zip: 22804
Email Address: bvo her@Valleyproteins:com .
Signatu
r Date:-,
Facility Name:.Valley Proteins - Wadesbom��T'F permit 8 W00000957
Countyt Anson i
YOU MUST SUBMIT A SEPARATE FORM FOR EACH TYPE AND CLASSIFICATION OF SYSTEM:
IOPEWOR�IN RESPONSIBLE CHARGE1ORC
.Print.Full.Name: James. Hodges Work:Phone: [phone]
;Certificate Type: "WW Certificate Grade: 11 - Certificate Il: 991972
Emall:Addeess:. Jhodges Salleyproteihs.com
1.Signature:, Date:
"l.,certo that l agree my designation as the Operator In Re nslble Charge for the facility noted- l understan and wl I abide by the
rules and regulatio pertaining to the respansibilltl05 of.th Re ' Set forth7n ISA, NCAC 08G .0204 andfailing. to do so can result in
DisciplinaryActla by the Water Polluttoln Control System Operators Cert ycatlan Caminlsslon."
BA&UP.ORC .
:Print Full Name:.JonethamKfrby
. 3 Work Phone: [phone]
Zertificate.Typec WW Certificate Grades III Certificate #s1000459
-Email Address: -Jkirby@v Ileypr teins.com .... . .. .
Signature: I Date:
"I certijy that l a tomy designation as a Back-up'Operator in sponsible Chorge for the_facillty, noted. 1 understand and will by
the rules.ond.re ulatlons pertaining to the responsibllifles of the:ORC asset forth In 1SA NC4C 08G.0204 and falling to do so can result in
Disciolinary.Actions by the. Water Pollution Control System Operators Certif lcation Commission."
Mail, fax or emall WPCS0CC11618 Mail. Service Center,. Fax: [phone] Emalh [e-mail]
ORIGINAL to: Rale1gh,'NC27699 �1618
Mail or Fax . Asheville Fayetteville Mooresville. Raleigh
a CQPY.to: 2090 US Hwy 70 225 Green St., Suite 714 610 E. Center Ave.,'Suite 301 3800 Barrett Dr.
Swannanoa, NC 28778 Fayetteville, NC 28301-5043 Mooresville, NC 28118 .. 'Raleigh, NC 27609
Fax:[phone] Fax:910.486�707 Fax.[phone] - Fax:[phone]
Phone:82&296-4500 Ph9":910-433.3300. Phone:.704663=1699.. Phone:[phone] .
Washington Wilmington Winston-Salem
943 Washington S . Mall .127-Cardinal Dr. 45-W. Hanes Mall Rd.
Washington, NC 2,889.. Wilmington, NC 28405.284S. ' Winston-Salem, NC 27105
Fax:•252.946-9215{ Fax; 910.350-2004. Fax:[phone] "
Phone:[phone]I Phone; 9.10-79.6=7215 Phone:[phone] Rovtaed4�o:e
Facilit T � e:
WW
'Faclltt Grade:
11