WQ0002708_Wrenn Road WWTF_20231101

11/08/2023 09:41 9196625707 NEUSE RIVER WWTP PAGE 02/04
Water Pollution Control System OPERATOR IN RESPONSIBLE CHARGE (ORC) Designation Form
NCAC 15A 8G ,0201
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Facility Name:
VII'renn Road WWTF Permit # WQ0002708
Facility Type: SI EJ Facility Grade: Select SU8M1T A SEPARATE FORM FOR EACH CLASSIFICATION
DePt of
?11(y
Permittee Owner/Officer Name. Lisa Joseph
Email Address: [e-mail] NOV 8 _ 2023
Permittee Signature•
ORC
Operator in Responsible Charge
Full Name: Christopher Ray Work Phone: [phone]
Email Address: christopher.raypraleighnc.gov
V"nify
Ce lcate Grade: N!A Certificate #: 1003564
Certificate Type:////Effective Date: /!-*'Signature:J tkvm�
o my eslgnatiori as the Operator in Responsible Charge for the facility noted. !understand and will
'abide by r regulations pertaining to the responsibilities of the ORC as set forth in SSA NCAC QBG .07.Q4 and
failing to do so can result in Disciplinary Actions by th& Water pollution Control System Operators Certification Commission.'
Full Name:
Backup ARC
Christopher Sauls Work Phone: [phone]
Certificate Type: Sl
El
Certificate Grade: NIA — Q
Certificate #:
1005244
Effective Date:
Signature:
"l certify that i agree to my designation as a Back-up Operator in Responsible charge for the f'aClfity noted. a understand and will
abide by the rules and regulations pertaining to the responsibilities of the ORC as set North in 15A NCAC 08G .0204 and falling to
do so can result in Disciplinary Actions by the Water pollution Control System Oper'ators Certification commission."
Baickup ORC
Work Phone:
Full Name:
Certificate Type: Select Certificate Grade. Select Certificate st:
Effective Date:
Signature:
"! certify that 1 agree is my designation as a Beek -up Operator In Responsible charge for the facility noted, f understand and will
spansfbilirics of the ORC as set forth in 25A NCAC OSG .Q204 and falilnp to do
abide by the rules and regulations pertaining to the re
so :on result in Disciplinary Actions by the Water Pollution Control System Operators Certifitatlon Commission."
Mail, fax or email ORIGINAL to: WPCSOCC,1615 Mail 5ervice Center, Raleigh, NC 27699-1618 1 FAX: 919-71S-2726 I [e-mail]
Mail or fax a COPY to: Choose DWR Regional Office that has coverage of this facility.
Rewhwd W023