NC0044784_ORC Designation Form_20240807

Water Pollution Control System OPERATOR IN RESPONSIBLE CHARGE (ORC) Designation Form
NCAC 15A 8G .0201
TAU to Navigate Form
Facility Name: City of Brevard Water Plant Permit it NCO044784
Facility Type/Classification: PC 0 Facility Grade: 1 F-1 SUUMITA SEPARATEFORM FOR EACH CLASSIFICATION
Permittee Owner/Officer Name: Wilson Hooper - Brevard City Manager
Email Address:
Permittee Signature:
ORC
Full Name:
Dennis Alan Richardson
Work Phone:
[phone]
Email Address:
[e-mail]
Certificate Type:
Grade: I 0
PCqq 0
Certificate #:
999228
Signature:
/nCertificate
V/al- t
Effective Date:
"I certify that agree to my designation as the Operator In Responsible Chargeforthe facllity noted.
I understand and will abide by the rules and regulations pertaining
to the responsibilities ofthe ORCm setforth in 15A NCAC08G.0204 and faillog to do socan result In
Disciplln ayActiuns by the WPCSOCC
Backup ORC
Full Name:
Mathew Corey Morgan
Work Phone:
[phone]
Certificate Type:
PC _. Certificate Grade: I
Certificate
1009051
Signature: �Ci"`y // � Effective Date: T-7-a t/
"I certify that l agree to my designation as the Operator In Responsible Charge for thefacllity noted. lunderstandandwlll abide by the rules and regulations pertaining
to the responsibilities of the ORC m setforth in 15A NCAC 08G.0204 and foiling to do so Con result in Disciplinary Actions by the WPCSOCC"
Backup ORC
Full Name: Work
Certificate Type: Select Certificate Grade: Select Certificate
Signature: Effective Date:
"I certify that l agree to my designation as the Operator in Responsible Charge far the facility noted. lunderstandandwill abide by the roles and regulations
pertaining to the responsibilities of the ORC as setforth in 15A NCAC 08G.0204 andfolling to do so dad result In Dlsclilh aryActions 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:(Choose DWR Regional Office that has coverage of this facility.
Use the 2nd page only If you need to list additional Backups.
RBNeed02/2024