NC0032891_ORC Designation Form_20240827

Water Pollution Control System OPERATOR IN RESPONSIBLE CHARGE (ORC) Designation Form
Facility Name:
CHARLOTTE TERMINAL 1
NCAC 15A 8G .0201
TAB to Navigate Form
Permit # NCO032891
Facility Type/Classification: PC Facility Grade: I SUBMlTASEPARATE FORM FOR EACH CLASSIFICATION
Permittee Owner/Officer Name: Kinder Morgan Southeast Terminals / Wayne Harvey
Email Address: [e-mail]
Permittee Signature: LDate: 8/27/24
ORC
Full Name: Joseph Byers
Work Phone:
[phone]
Email Address: [e-mail]
Certificate Type: PC Certificate Grade: I
Certificate #:
1010231
Signature: /
Effective Date:
�' 2''4(, ' ;zvA
"Icertify thati 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 os set forth in 15A NCAC 08G .0204 and failing to do so can result in DisciplinaryActions by the WPCSOCC"
Backup ORC
Full Name: Matthew Joseph Brundage
Work Phone:
[phone]
Certificate Type: PC Certificate Grade: I
Certificate #:
1002738
Signature:`' "'���
Effective Date:
August 26, 2024
"1 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 Oisciplinory Actions by the WPCSOCC"
Backup ORC
Full Name: Gary W Simcox
Work Phone:
[phone]
Certificate Type: PC Certificate Grade: I
Certificate #:
28893
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Signature:
Effective Date:
August 26, 2024
"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 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: Mooresville-610 E. Center Ave., Suite 301, Mooresville, NC 281151 FAX: [phone] PH: 704-663-�
Use the znd page only if you need to fist additional Backups.
Revised 0212024

Facility Name: CHARLOTTE TERMINAL 1 Permit #: NCO032891
Backup ORC
Full Name:
Work Phone:
Certificate Type: Select Certificate Grade: Select
Certificate #:
Signature:
Effective Date:
"1 certf, that I agree to my designation as the Operatorin Responsible Charge for the focllity noted.
I understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORCos set forth in 15A NCAC08G.0204 and falling to do so can result In DiscipltnaryActions by the WPCSOCC"
Backup ORC
Full Name:
Work Phone:
Certificate Type: Select Certificate Grade: Select
Certificate #:
Signature:
Effective Date:
"I certify that I agree to my designation as the Operatorin Responsible Charge far 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 NCAC08G.0104 and falling to do so can result in DisclpllmryActions 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 Operatorin Responsible Charge for the focllity noted.
I understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORC as set forth in 15A NCAC08G.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:
"I certify that I agree to my designation as the Operatorin Responsible Charge for the facility noted.
1 understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORCas set forth in 15A NCAC08G.0204 ondfa/8ng to do so can result In
Disciplinary Actions by the WPCSOCC"
Revised 0212024