WQ0043463_ORC Designation Form_20230807

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Fac*ilioty Name,: CEDAR RUN CAPITAL LLCO=FAIV Perill t #:
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Signature:
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rrl C�1"�� thCl�' �'i�C�►ree to
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esignation as a Back-up Operato
r in
iliti
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abide by the rules and.,!A!gulotions pertaining to the responsib
do so can result inh:D�l,scipli
WQ0043463
Effective Date:
nsible Charge for t
ass
nary Actions by the Water Pollution Control System Operas
es of the'
hefacility noted. 1
Page 2
understand and will
et forth in 15A NCAC 08G,.0204 and fa
zs Certification Commission.
"
Certificate Type: its � �� Certificate Grade: � Certificate #:
Signature:
Sgnature:i
7
Effective Date:
rS'
t
Ry
Yr�..
ding to
"I certify that / agree to nay designation as a Bask -up Operator In Responsible Charge far� the �`acilrty noted, 1 understand and will
abide fey the rules and regulations pertaining toa fie responsibilities of the ORC as setforth in 15A NCAC 08G.0204 andfailing to
coo so carp result in Disciplinary Actions bar the Water Pollution Control System Operators Certification Commission. P'
WM
IN
Effective Date.*
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Loll
"I �lfy�that t agree to my designation as a Back-up Operator in Responsible Charge for thefacility noted. !understand and will
abide by the rules and regulations pertainrng to the responsibilities of the ORC asset forth in 15A NCAC 08G .0204 andfailing to
do so can result in Disciplinary Actions by the Water Pollution Control System Operators Certification Commission,"-'
Certificate Type: R-Alect Certificate Grade: Select Certificate #: