NC0026921_Correspondence_19990712

NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
ED
July 12 1999 E- ��
Ji L 1 6 1999
FAYETTE ILLE
olina 28371 -
REO'. OFFICE
in Responsible Charge/Back-Up -Operator,Designation
VC0026921
-ounty
n Control System Operators Certification Commission hereby classifies
as a Class 2 Biological Water Pollution Control Treatment System.
cn Control System Operators Certification Commission has reviewed
orm pertaining to the designation of Janet Gouveia, as the Back-up
ted facility. Ms. Gouveia is not certified and cannot be designated as the
for this facility. Please designate a certified -Back-up Operator with at
tewater certification or contact our office by August 12, 1999. Failure to
[y certified ORC and Back-up Operator by the above date constitutes a
mit issued for this facility. '
:stions concerning this matter, please contact me at 91gn33-0026 ext. 315.
ce and Certification
r, Permits and Engineering
;gional=Office ��
WATER POLLUTION CONTROL SYSTEM OPERATORS CERTIFICATION COMMISSION
C 29535, RALEIGH, NORTH CAROLINA 27626-OS35 PHONE'919-,733-0026 FAX [phone] .
AN EQUAL OPPORTUNITY /AFFIRMATIVE ACTION EMPLOYER - SO% RECYCLED/10% POST -CONSUMER PAPER -

DESIGNATION FORM
OPERATOR IN RESPONSIBLE CHARGE OF
WATER POLLUTION CONTROL SYSTEMS
FACILITY INFORMATION: • -
Please Print FacilityNamee
Mailing Address:; \
City:.: -__ \ State: Zip Code•
..Permit Number County: _
?lease'Check Type of Facility:
-Wastewater Class I _ Class II Class III ` :Class IV -.
= .Collection -Glass 'I < :: Class II = - : Class III = Class IV-.
Spray Irrigation . _ Land Application . Subsurface
:.;OPERATOR _IN tESPONSIBLE..CHARGE . - _ - =
`Please Print
Mailing Address t _ -
City: State: `: -.Zip Code:
Certificate T ^es and Grade
.Certificate #s
Social Security #•
Work Phone: `= _ _ .. -Home Phone:
Signature:.Date: =
BACK=TP.OPERATO_ R'
Please Print Name.
Mailing Address: -
City; - < -' .._ State: - - Zip Code:
- _ -•
:Certificate Types and Grade:
-.Certificate #s- = - Social Security #:--------------
._., . .
: Work Phone:-"-. .::: '_: : Home Phone:
Signature: _ - - :.'Date:
SYSTEM-OWNER/ADMIN. OFFICER _ - -
Please Print Name::`:_
Mailing Address
_
.City _ = . SYatec: - Zip Code:'..
•Telephone # " -
Signature - - - - = :Date:
_ Please Mail to H ---k,,- - • , - . - � � - -• • _ �- - .
WPCSOCC
--PO'Box 29535
•Raleigh, NC 27626-0535 - Y