NC0078131_ORC_20240415

RECEIVED/NCDENR/DWR
Water Pollution Control System OPERATOR IN RESPONSIBLE CHARGE (ORC) Designation
1 b 2024tion Form
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NCAC 15A 8G .0201
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Facility Name: CITY OF HAVELOCK WATER TREATMENT PLANT
Water Quallty
Regiicnal Operations Section
Permit # Wafq6ftgqjTaj Office
Facility Type/Classification: P~ Facility Grade: it R SUBMITA SEPARATE FORM FOR EACH CLASSIFICATION
Permittee Owner/Officer Name: Christopher W McGee
Email Address: [e-mail]
Permittee Signature: Date: / % )9)0/ 1 Lf
ORC
Full Name: David R Hemenway Work Phone: [phone]
Email Address: d
us
Certificate Type: PC Certificate Grade: I Certificate #: 28581
Signature: Effective Date: /� li, Y
'I 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 falling to do so can result in Disciplinary Actions by the WPCSOCC'
Backup ORC
Full Name: Timothy Edward McClellan Work Phone: [phone]
Certificate Type: PC
Certificate Grade: I
Certificate #: 1014838
Signature: Effective Date: 4111
'1 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 responslblihies of the ORC as set forth In 15A NCAC 08G .0204 and falling to do so can result In Disciplinary Actions by the WPGSOCC'
Backup ORC
Full Name:
Certificate Type: Select
Signature:
Certificate Grade: Select
Work Phone:
Certificate #:
Effective Date:
'1 certify that I agree to my designation as the Operator In Responsible Marge for the faculty 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 falling 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: Washington-943 Washington Sq. Mall, Washington, NC 27889 1 FAX: [phone] PH: 252-346-648'
Use the 2nd page only if you need to list additional Backups.
Revised 0212024

Cindy Morgan RECEiVEDINCDENR/DWR
From:
Cindy Morgan
Sent
Thursday, April 11, 2024 3:02 PM
APR 15 2024
To:
[e-mail]
Cc:
Rick Day; David Hemenway
Water Quality
Section
RegionSubject:
1
WTP ORC Designation Form
9
l O
Washington Reg"ronat otAce
ton ROpe-egional
Washington
Attachments:
WTP ORC and Backup ORC.pdf
Attached is the executed ORC and Backup ORC designation form for the Havelock Water Treatment Plant. An original
will be mailed to the Washington DEQ Office.
Please let us know if you need anything else.
Thanks —
Cindy K. Morgan, CMC, NCCMC
Assistant City Manager
City of Havelock
1 Governmental Avenue
PO Box 368
Havelock, NC 28532
Phone: [phone]
Fax: [phone]
crnorgan(@haveIQcknc.us
www.havelocknc.us