WQ0003396_ORC Designation Form_20240307

Water Pollution Control System OPERATO � 8ESPONSIBLE CHtAli2 E ( RC) Designation Form
ept n nv!rormen a �ua Qy
NCAC 15A 8G .0201
Facility Name: ARAUCO NA
Facility Type/Classification: WW
TAB to Navigate Form
MAR 7 2024
Permit # WQ0003396
Facility Grade: llaleigh AMA TE FORM FOR EACH CLASSIFICATION
Permittee Owner/Officer Name: Jeff McMillian - Plant Manager
Email Address: [e-mail]
Permittee Signature: _ Date: `f
Full Name: Wentworth
Email Address: [e-mail]
Certificate Type:
ORC
Operator in Responsible Charge
Work Phone: [phone]
WW Certificate Grade: IV Certificate #: 1010091
Signature:
` Effective Date: V3pbo 2 y
"l certify that l agree to my designation as the Operator in Rorponsible Charge for the facility noted. 1 understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORC as set forth in 15A NCAC 08G . 0104 and failing to do so can result in Disciplinary Actions by the WPCSOCC"
Backup ORC
Full Name: Kevin Glass Work Phone: [phone]
Certificate Type: _ Certificate Grade: I Certificate #: 1014491
Signature: �ai Effective Date: "'L2 ( 2d Z`/
"I certify that t agree to my designation as the Operator in Responsible Charge for the facility noted. ! understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORC asset forth in 15A NCAC 08G .0204 and failing to do so can result in Disciplinary Actions by the WPCSOCC'
Backup ORC
Full Name: Patrick Mays Work Phone: [phone]
Certificate Type: WW Certificate Grade: II Certificate #: 1009460
Signature: Effective Date:_04
"l certify that 1 agree to desig a ' as the Operator in Responsible Charge for the facility noted. i understand and will abide by the rules and regulation
pertaining to the respo sibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to do so can result in Disciplinary Actions by the WPCSOCC"
Email this form to: [e-mail]
AND
Send to your DEQ Regional Office (send to your contact or find emails here: www.deq,nc.gov/about/contact/regional-offices
or fax using this drop down list: Raleigh-3800 Barrett Dr.,Raleigh, NC 27609 1 FAX: [phone] PH: 919-791-4200
Use the 2nd page only if you need to list additional Backups.
Revised 11t2428

Facility Name: ARAUCO NA Permit M WQ0003396
Backup ORC
Full Name: Rawindraraj Mylvaganam
Work Phone: [phone]
Certificate Type: WW Certificate Grade: li
Certificate M 1007617
Effective Date: 0� 1
Signature:
"I certify that 1 agree to my designation as the Operator in Responsible Charge for the facility noted.
i understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to do so can result in
Disciplinary Actions by the WPCSOCC"
Backup ORC
Full Name:
Work Phone:
Certificate Type: Select Certificate Grade: Select
Certificate M
Signature:Effective
Date:
"I certify that i agree to my designation as the Operator in Responsible Charge jar the facility noted.
1 understand and writ abide by the rules and regulations pertaining
to the responsibilities of the ORC as set forth in ISA NCAC 08G , 0104 and failing to do so can result in Disciplinary Actions by the WPCSOCC"
Backup ORC
Full Name:
Work Phone:
Certificate Type: Select Certificate Grade: Select
Certificate #:
Signature:
Effective Date:
"1 certify that I agree to my designation as the Operator in Responsible Charge for the facility noted.
i understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to do so can result in Disciplinary Actions by the WPCSOCC'
Backup ORC
Full Name:
Work Phone:
Certificate Type: Select Certificate Grade: Select
Certificate M
Signature: Effective Date:
certify that I agree to my designation as the Operator in Responsible Charge for the facility noted. I understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORC as set forth in 15A NCAC 08G , 0204 and failing to do so can result in Disciplinary Actions by the WPCSOCC"
Revised 11/2023

Water Pollution Control System OPERATOR IN RESPONSIBLE CHARGE (ORC) Designation Form
Facility Name:
ARAUCO NA
NCAC 15A 8G .0201
TAB to Navigate Form
Permit # WQ0003396
Facility Type/Classification: Sl Facility Grade: I SUBMIT SEPARATE FORM FOR EACH CLASSIFICATION
Permittee Owner/Officer Name: Jeff McMillian - Plant Manager
Email Address: [e-mail]
Permittee Signature: 949Date: hild
ORC
Operator in Responsible Charge
Full Name: Wentworth Durgin
Email Address: [e-mail]
Work Phone: [phone]
Certificate Type: Sl Certificate Grade: I Certificate tl: 1011886
Signature: Effective Date:
"I certify that l agree to my designation as the Operator in Responsible Charge for the facility noted. 1 understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and farong to do .so can result in Disciplinary Actions by the WPCSOCC"
Backup ORC
Full Name:
Kevin Glass Work Phone: [phone]
Certificate Type: Sl Certificate Grade: I Certificate #: 1014449
Signature: _ _ _ Effective Date:
"1 certify that 1 agree to my designation as the Operator in Responsible Charge for the facility noted. 1 understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to do so can result in Disciplinary Actions by the WPCSOCC"
Backup ORC
Full Name: Patrick Mays
Work Phone: [phone]
Certificate Type: Sl Certificate Grade: I Certificate #: 1010112
Signature: Effective Date:
"1 certify that I agree to my designationAlstherator /R,4, rl;�Chargejor the facility noted. 1 understand and will abide by the rules and regulot
pertaining to the responsibilities of the ORC as set forth in 1 SA NCAC 08G .0204 and failing to do so can result in Disciplinary Actions by the WPC50CC"
Email this form to: [e-mail]
AND
Send to your DEQ Regional Office (send to your contact or find emails here: www.deq.nc.gov/about/contact/regional-offices
or fax using this drop down list: Raleigh-3800 Barrett Dr.,Raleigh, NC 276091 FAX: [phone] PK 919-791-4200
Use the 2nd page only if you need to list additional Backups.
Revised 1112023

Facility Name: ARAUCO NA Permit M W00003396
ackup ORC
Full Name: Work Phone:
Certificate Type: Select Certificate Grade: Select Certificate M
Signature: Effective Date:
"I certify that l agree to my designation as the Operator in Responsible Charge for the facility noted I understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORC asset forth in 15A NCAC 08G .0204 and failing to do so can result in Disciplinary Actions by the WPCSOCC"
Backup ORC
Full Name: Work Phone:
Certificate Type: Select Certificate Grade: Select Certificate M
Signature: Effective Date:
certify that I agree to my designation as the Operator in Responsible Charge for the facility noted. 1 understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and failing to do so can result in Disciplinary Actions by the WPCSOCC"
Backup ORC
Full Name: Work Phone:
Certificate Type: Select Certificate Grade: Select Certificate #:
Signature: _ ___ . _ Effective Date:
certify that 1 agree to my designation as the Operator in Responsible Charge for the facility noted. 1 understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORC asset forth in 15A NCAC 08G .0204 and failing to do so can result in Disciplinary Actions by the WPCSOCC"
Full Name:
Certificate Type: Select
Backup ORC
Certificate Grade: Select
Work Phone:
Certificate M
Signature: Effective Date:
"I certify that I agree to my designation as the Operator in Responsible Charge for the facility noted. l understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORC asset forth in 15A NCAC 08G .0204 and failing to do so can result in Disciplinary Actions by the WPCSOCC-
Revised 1112023