310160_OIC Designation Form_20240826

Animal Waste Management System Operator Designation Form
WPCSOCC
NCAC 15A 8F .0201
Facility/Farm Name: Carter & Sons Hog Farm 1 &2
Permit #. AWS310160
Facility ID#: 31 160 County: Duplin
Operator In Charge (OIC)
Name: Jimmy D. McLamb
- Jr. 31r, ere.
Cen Type / Numbe AWA 19091 Work Phone: ( )
� G
Signature:
Date:
"I certify thatF-2.designation as the Operator in Charge for the facility noted. I understand and will abide by the rules
and regulations pertaining to the responsibilities set forth in 15A NCAC 08F .0203 and failing to do so can result in Disciplinary
Actions by the Water Pollution Control System Operators Cenification Commission."
Back-up Operator In Charge (Back-up OIC) (Optional)
First bfiddte crest Jr. Sr ere.
Cert Type / Number: Work Phone: ( )
Signature: Date:
"I certify that I agree to my designation as Back-up Operator in Charge for the facility noted. I understand and will abide by the
rules and regulations pertaining to the responsibilities set forth in 15A NCAC 08F .0203 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission.•'
Owner/Permittee Name: Coy Carter
Phone #: a 10 )a %4 — a S a 5 Fax#: ( )
Signature: Date:l aL B a- Li(Owner or on agent)
Mail or fax to: WPCSOCC
1618 Mail Service Center
Raleigh, N.C. 27699-1618
Fax:[phone]
(Retain a copy of this form for your records)
Revised W007