NCG050153_SW Permit DOSA_20240312

I.'
ROY COOPER }l
Governer' •✓ -I` �1F"
ELIZABETH S.BISER • ""4._
Secretory 4r
DOUGLAS R.ANSEL NORTH CAROLINA
Interim Director Environmental Qualify
Stormwater Delegation of Signature Authority Form (DOSA)
This form shall be used to delegate signature authority from the permit Owner (Permittee) to
another party. Only the Responsible Official defined below may submit permit applications and
reports required by the permit(such as Data Monitoring Reports and Annual Reports) until this
form is completed and submitted to the DEMLR Stormwater Program. Please note that delegating
signature authority does not relieve the Permit Owner from the responsibility and compliance for
permit compliance.
Permit Owner:The legal entity to which/whom a permit has been issued and maybe an individual
or an organization such as a company or government agency. Every Owner is required to have a
Responsible Official who meets the legal signature authority requirements in 40 CFR 122.22,
summarized below:
• For a corporation,the Responsible Official shall be a president,secretary,treasurer,or vice president
in charge of a principal business function,or another individual who performs similar functions for
the corporation,or the manager of one or more manufacturing production,or operating facilities
who is authorized to make management decisions about the facility operation.
• For a partnership or sole proprietorship,the Responsible Official shall be a general partner or the
proprietor,respectively;or
• For a municipality,State,Federal,or other public agency,the Responsible Official shall be either a
principal executive officer[City/County Manager]or ranking elected official[Mayor].
Please mail the DOSA Form with original wet signatures to: NCDEMLR Stormwater
Program, 1612 MSC,Raleigh, NC 27699-1612
Name of Organizational Entity
Cascades Tissue Group-Rockingham,a division of Cascades Holding US Inc.
Responsible Official Name
Pascal Perreault
Responsible Official Title: Vice-President Operations, Cascades Tissue Group
Email Address: Phone
pascal [e-mail] 514)-773-1074
Mailing Address
PO Box 578, 805 Midway Rd.
City State Zip code
Rockingham NC 28380-0578, 28379
® North Carolina Department of Environmental Quality I Division of Energy.Mineral and Land Resources
��Ct 512 North Salisbury Street 1612 Mail Service Center Rakich.North Carolina 2769n 1612

A. Persons to Receive Signature Authority
The signatures of the persons listed below indicates their acceptance of signatory authority.
Attach additional pages if you need more space.
Delegated Party Name John Quick (Primary)
Delegated Party Title Mill Manager
Permit Number(s) NCG050153
Email Address: [e-mail] I Phone I 901-489-6520
Mailing Address PO Box 578, 805 Midway Rd.
City Rockingham State NC Zip code 28380-0578.2837S :
indicating
a Delegated Party
indicating acceptance of
Signatory Authority:
Date 642/2ozi
Delegated Party Name Michael Hurst
Delegated Party Title Environmental Manager
Permit Number(s) NCG050153
Email Address: [e-mail] Phone [phone]
Mailing Address PO Box 578, 805 Midway Rd.
City Rockingham State NC I Zip code 28380-0578,28379
Signature of Delegated Party
indicating acceptance of •
Signatory Authority:
Date 3/(2/2O24/
T
Delegated Party Name
Delegated Party Title
Permit Number(s)
Email Address: Phone I
Mailing Address
City State Zip code
Signature of Delegated Party
indicating acceptance of
Signatory Authority:
Date I
Stormwater Permit Delegation of Signatory Authority Form
Page 2

B. Responsible Official Signature
The Responsible Official,as identified in accordance with 40 CFR 122.22,is the appropriate
individual with the authorityto sign and submit reports for the organization.
As the Responsible Official,I, Pascal Perreault (printed name),
have the authorityto enter into this Agreement for
Cascades Tissue Group-Rockingham,a division of Cascades Holding US Inc.
(Owner/Organization Name).
I request that the DE MLR Stormwater Program include the persons listed in Part A of this
form signatory authority for the above-named permit.
I acknowledge that I,and the persons listed in Part A of this form work at/for my
organization and have authorityto act as a signatory for purposes of the NCDEQ's
electronic document systems.
By submitting this application,I, Pascal Perreault (printed name),have read,
understand,and accept the terms and conditions of the stormwater permit(s)for which I
am the Responsible Official.
/:7
Respons. I Official Signature
Vice-President Operations.Cascades Tissue Group -rti L
p-•,tL IZ l 202 /
Title Date
Stormwater Permit Delegation of Signatory Authority Form
Page 3