NCG060029_SW Permit DOSA_20240515

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ROY COOPER '' :`
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Governor —!)
ELIZABETH S.RISER �Q�� ,---
Secretary
DOUGLAS R.ANSEL NORTH CAROLINA
Interim Director Environmental Quality
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 may be 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: NCDEMLRStormwater
Program, 1612 MSC,Raleigh, NC 27699-1612
Name of Organizational Entity Campbell Soup Supply Co., LLC
Responsible Official Name
Mark Rogers
Responsible Official Title: Associate VP, Site Operations
Email Address: [e-mail] Phone [phone]
Mailing Address 2120 HWY 71 North
City Maxton State NC Zip code 28364
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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 Mark Rogers
Delegated Party Title Associate VP, Site Operations
Permit Number(s) NC060029
Email Address: [e-mail] Phone [phone]
Mailing Address 2120 HWY 71 North
City Maxton State I NC Zip code 28364
Signature of Delegated Party
indicating acceptance of
Signatory Authority: �
/C01-21-0-4.0--
Date
Delegated Party Name
Delegated Party Title
Permit Number(s)
Email Address: Phone
Mailing Address
City State Zip code
Signature of Delegated Party
indicating acceptance of
Signatory Authority:
Date
Delegated Party Name
Delegated Party Title
Permit Number(s)
Email Address: Phone
Mailing Address
City State Zip code
Signature of Delegated Party
indicating acceptance of
Signatory Authority:
Date
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 authority to sign and submit reports for the organization.
As the Responsible Official,I, Mark Rogers (printed name),
have the authority to enter into this Agreement for
Campbell Soup Supply Co., LLC (Owner/Organization Name).
I request that the DEMLR 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 authority to act as a signatory for purposes of the NCDEQ's
electronic document systems.
By submitting this application,I, Mark Rogers (printed name),have read,
understand,and accept the terms and conditions of the stormwater permit(s)for which I
am the Responsible Official.
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Responsible Official Signature
Associate VP,Site Operations o2-- 7-a 1
Title Date
Stormwater Permit Delegation of Signatory Authority Form
Page 3

NC Department of Environmental Quality
Division of Energy, Mineral and Land Resources
NORTH CAROLINA
Environmental Quality
Stormwater eReporting Registration Form
Directions are in red.
Completion of the Stormwater Electronic Reporting (eReporting) Registration Form is a required
step for the Owner and, if applicable, Facility Administrator(s) to obtain the privilege of
submitting electronic reports to DEQ and in lieu of submitting paper reports.
In addition, this form allows for Owners to designate Responsible Officials and Facility
Administrators who can act on their behalf. Responsible Officials and Facility Administrators
must agree to the Electronic Signature Agreement(ESA) Conditions contained in this form.
A. Owner Information
The Owner is the legal entity to which/whom a permit has been issued. The Owner may be an
individual or organization. Every Owner is required to have a Responsible Official who meets
the legal signature authority requirements in 40 CFR 122.22.
• For a corporation, this individual shall 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, this individual shall be a general partner or the proprietor,
respectively; or
• For a municipality, State, Federal, or other public agency, this individual shall be either a principal
executive officer or ranking elected official.
Owner Name: Campbell Soup Supply Co., LLC
Responsible Official Name: Mark Rogers Title: Associate VP-Site Operations
Does the Responsible Official If Yes,
already have an eDMR account? El Yes ❑✓ No User ID:
Email Address: [e-mail] Phone: [phone]
Mailing Address: 2120 NC Hwy 71 N
City: Maxton State: NC Zip: 28364
Stormwater Electronic Reporting Registration Form
Page 1

B. Permit Information
Include all stormwater permit currently held by the Owner(both Individual and General permits).
Designate any applicable Facility Administrators for each permit. Attach additional pages if you
need more space.
Facility Administrator(s)
Permit No. Facility Name Facility Address (if applicable)
NCG0600629 Campbell Soup Supply co.LLC 2120 NC Hwy 71 N Mark Rogers
Aaron Rife
Liz Ward
Ruth Trotman
i - Stormwater Electronic Reporting Registration Form
Page 2

C. Facility Administrator Information
Include the following information for all Facility Administrators listed in Part B. Attach additional
pages if you need more space.
Facility Administrator for Permit Number: _ NCG060029
Name: Mark Rogers Title: Associate VP-Site Operations
Do you already have an eDMR If Yes,
account? ❑Yes ✓❑No User ID:
Organization: Campbell Soup Supply Co. LLC
Email Address: [e-mail] Phone: [phone]
Mailing Address: 2120 NC Hwy 71 N
City: Maxton State: NC Zip: 28364
Facility Administrator for Permit Number:
Name: Title:
Do you already have an eDMR If Yes,
account? ❑Yes ❑No User ID:
Organization:
Email Address: Phone:
Mailing Address:
City: State: Zip:
Facility Administrator for Permit Number:
Name: Title:
Do you already have an eDMR If Yes,
account? Yes ❑No User ID:
Organization:
Email Address: Phone:
Mailing Address:
City: State: Zip:
Facility Administrator for Permit Number:
Name: Title:
Do you already have an eDMR If Yes,
account? ❑Yes ❑No User ID:
Organization:
Email Address: Phone:
Mailing Address:
City: [State: Zip:
Facility Administrator for Permit Number:
Name: Title:
Do you already have an eDMR If Yes,
account? ❑Yes ['No
User ID:
Organization:
Email Address: 1 Phone:
Mailing Address:
City: r State: Zip:
Stormwater Electronic Reporting Registration Form
Page 3

D. Electronic Signature Agreement Conditions
To receive and accept the required electronic signature credential, consisting of a User ID and
password, issued by the North Carolina Department of Environmental Quality (NCDEQ) in order
to sign electronic documents submitted to NCDEQ's Electronic Document Systems and to
receive electronic documents from NCDEQ's systems;
The Responsible Official and Submitter(s) (if applicable) named in this form do herby:
1. Understand that this Electronic Signature Agreement requires me to submit electronic
documents to NCDEQ's approved eDMR system under the authorized program in lieu of paper
submissions.
2. Understand that this Electronic Signature Agreement requires me to accept electronic
transmissions, in lieu of paper transmissions of all permits, permit modifications, authorizations
to construct, and any other correspondence related to reviewing and processing permits from
NCDEQ. This authorization will not become effective until NCDEQ establishes a system for
processing electronic documents; I am notified in writing from NCDEQ that use of the electronic
systems has officially been initiated; and North Carolina rules and statutes are changed to allow
the implementation of electronic submittal and acceptance of documents.
3. Understand that this Electronic Signature Agreement requires me to submit electronic all
necessary information for processing of NPDES application including information for renewal of
existing permits, modification to existing permits, and applications for new discharge permits.
The submittals may include all necessary applications and supporting documentation to
NCDEQ's approved system for electronic submittals in lieu of paper submissions. This
authorization will not become effective until NCDEQ establishes a system for processing
electronic documents; I am notified in writing from NCDEQ that use of the electronic systems
has officially been initiated; and North Carolina rules and statutes are changed to allow the
implementation of electronic submittal and acceptance of documents.
4. Understand that this Electronic Signature Agreement requires me to accept electronic
submissions, in lieu of paper submissions, of all Notices of Deficiency, Notices of Violation, Civil
Penalty Assessments, and any other correspondence related to compliance with federal and
state water quality laws and regulations that might be sent by NCDEQ. This authorization will
not become effective until NCDEQ establishes a system for processing electronic documents; I
am notified in writing from NCDEQ that use of the electronic systems has officially been
initiated; and North Carolina rules and statutes are changed to allow the implementation of
electronic submittal and acceptance of documents.
5. Agree to protect both the electronic signature credential, consisting of my User ID and
password, and security questions and answers, from compromise and from use by anyone
except me. Specifically, I agree to maintain the secrecy of my electronic signature credential
and security questions and answers; I will not divulge or delegate my credential or security
questions and answers to any other individual; I will not store my credential or security
questions and answers in an unprotected location; and I will not allow my electronic signature
credential or security questions and answers to be written into computer scripts to achieve
automated log-in.
6. Understand and agree that I will be held as legally bound, obligated, and responsible for the use
of my electronic signature as I would be using my hand-written signature.
7. Understand that I will be informed through my registered email address whenever my User ID
or password has been modified.
Stormwater Electronic Reporting Registration Form
Page 4

8. Understand that eDMR reports the last date my User ID and password were used immediately
after successfully logging into eDMR.
9. Agree to contact the NCDEQ SW-eDMR Administrator via email at SW-eDMR(a,ncdenr.gov as
soon as possible, but no later than 24 hours, after suspecting or determining that my User ID
and/or password have become lost, stolen or otherwise compromised.
10. Agree that I will review the contents of all electronic submissions prior to submission.
11. Understand that I will automatically receive an email receipt at my registered email address
from the NCDEQ's SW-eDMR system for any submission that contains a valid electronic
signature, identifying the document received, the signatory, and the date and time of receipt.
12. Agree to contact the NCDEQ SW-eDMR Administrator via email at SW-eDMRncdenr.qov if I
do not receive an email receipt as specified above within five (5) business days for any
electronically signed submission using my credentials.
13. Agree that if I received an email notification for an activity that I do not believe that I performed,
I will notify the NCDDEQ SW-eDMR Administrator via email at SW-eDMR(ncdenr.gov as soon
as possible, but no later than 24 hours, after receipt.
14. Agree to report, within 24 hours of discovery, any evidence of discrepancy between any
electronic document I have signed and submitted and what the NCDEQ eDMR has received
from me by contacting the NCDEQ SW-eDMR Administrator via email at SW-
eDMRAncdenr.gov.
15. Understand that the NCDEQ eDMR's system will automatically reject any electronic document
submitted without a valid electronic signature if such signature is required.
16. Agree to contact the NCDEQ SW-eDMR Administrator via email at SW-eDMRAncdenr.gov
within ten working days if my duties change and I no longer need to interact with eDMR on
behalf of my organization.
17. Agree to notify the NCDEQ SW-eDMR Administrator via email at SW-eDMR(ncdenr.gov if I
cease to represent the regulated entity specified above as signatory of that organization's
electronic submissions as soon as this change in relationship occurs.
18. Understand that the NCDEQ may contact the Organization's Responsible Official, who signs
below to authorize me as a signatory for the Owner/Organization, in order to verify my identity.
19. Agree to retain a copy of this signed agreement as long as I continue to represent the regulated
entity specified above as signatory of the Organization's electronic submissions.
20. Certify that I have the authority to enter into this Agreement on behalf of the Organization
identified above, and I am a signatory authorized to represent that Organization, and I am able
to sign and submit reports and other information on behalf of that Organization in the capacity
required by statute and/or regulation.
Stormwater Electronic Reporting Registration Form
Page 5

E. Responsible Official Signature
The Responsible Official, as identified in accordance with 40 CFR 122.22, is the appropriate
individual with the authority to sign and submit reports for the organization.
I, Mark Rogers (printed name), have the authority to enter into
this Agreement for Campbell Soup Supply Co., LLC (Owner/Organization Name).
I request the NCDEQ grant me and, if included in Part B of this form, the named Facility
Administrator(s), an electronic signature credential to submit and accept documents
electronically on behalf of my organization.
I acknowledge that I, and if included in Part B of this form, the named Facility Administrator(s),
work at/for my organization and have authority to submit and accept electronic documents and
act as a signatory for purposes of the NCDEQ's electronic document systems.
By submitting this application, I, Mark Rogers (printed name),
have read, understand, and accept the terms and conditions of this Electronic Signature
Agreement. I certify under penalty of law that I have personally examined and am familiar with
the information submitted in this application and all attachments and that, based on my inquiry
of those persons immediately responsible for obtaining the information contained in the
application, I believe that the information is true, accurate and complete. I am aware that there
are significant penalties for submitting false information, including the possibility of fine and
imprisonment.
Associate VP-Site Operations 42., a
Responsible Official Signature Title Date
[e-mail] 910-844-1574
Email Address Phone Number eDMR User ID
Stormwater Electronic Reporting Registration Form
Page 6

F. Facility Administrator Signature
Provide a separate page for every Facility Administrator listed in Part B.
Facility Administrators are users other than the Responsible Official who can submit this
agreement to request to sign reports electronically and other information and to accept
electronic documents.
l Ruth Trotman _ (printed name), am authorized by the Responsible
Official named in this document, who has the authority under the applicable standards, to enter
into this agreement for Campbell Soup Supply Co., LLC (Owner/Organization Name).
By submitting this application, I, Ruth Trotman _ (printed name),
have read, understand, and accept the terms and conditions of this Electronic Signature
Agreement. I certify under penalty of law that I have personally examined and am familiar with
the information submitted in this application and all attachments and that, based on my inquiry
of those persons immediately responsible for obtaining the information contained in the
application, I believe that the information is true, accurate and complete. I am aware that there
are significant penalties for submitting false information, including the possibility of fine and
imprisonment.
�� Environmental Consultant (.f� ada y
S ibmitter Signature Title Date
[e-mail] 910-624-2287
Email Address Phone Number eDMR User ID
Stormwater Electronic Reporting Registration Form
Page 7

F. Facility Administrator Signature
Provide a separate page for every Facility Administrator listed in Part B.
Facility Administrators are users other than the Responsible Official who can submit this
agreement to request to sign reports electronically and other information and to accept
electronic documents.
I, Liz Ward (printed name), am authorized by the Responsible
Official named in this document, who has the authority under the applicable standards, to enter
into this agreement for Campbell Soup Supply Co., LLC (Owner/Organization Name).
By submitting this application, I, Liz Ward (printed name),
have read, understand, and accept the terms and conditions of this Electronic Signature
Agreement. I certify under penalty of law that I have personally examined and am familiar with
the information submitted in this application and all attachments and that, based on my inquiry
of those persons immediately responsible for obtaining the information contained in the
application, I believe that the information is true, accurate and complete. I am aware that there
are significant penalties for submitting false information, including the possibility of fine and
imprisonment.
LA I/ki.k-42- Environmental Compliance Manager o a 10� ( ac� q
Sub er Signature Title Date
[e-mail] 910-844-1202
Email Address Phone Number eDMR User ID
Stormwater Electronic Reporting Registration Form
Page 7

F. Facility Administrator Signature
Provide a separate page for every Facility Administrator listed in Part B.
Facility Administrators are users other than the Responsible Official who can submit this
agreement to request to sign reports electronically and other information and to accept
electronic documents.
I, Aaron Rife (printed name), am authorized by the Responsible
Official named in this document, who has the authority under the applicable standards, to enter
into this agreement for Campbell Soup Supply Co., LLC (Owner/Organization Name).
By submitting this application, I, Aaron Rife (printed name),
have read, understand, and accept the terms and conditions of this Electronic Signature
Agreement. I certify under penalty of law that I have personally examined and am familiar with
the information submitted in this application and all attachments and that, based on my inquiry
of those persons immediately responsible for obtaining the information contained in the
application, I believe that the information is true, accurate and complete. I am aware that there
are significant penalties for submitting false information, including the possibility of fine and
imprisonment.
Enviromental,Health&Safety Manager 6f- 2
,e
Submitter Signatur Title Date
[e-mail] 304-677-7023
Email Address Phone Number eDMR User ID
Stormwater Electronic Reporting Registration Form
Page 7