WQ0012796_ORC Designation Form_20240903

Water poll
ution Control System OPERATOR IN RESPONSIBLE CHARGE (ORC? Designation Form
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Facility Name: HM ALLIANCE - LA ORANGE WWTF Permit N W00012796
FacilityTypc/classification: SI Facility Grade: N/A i SUBMIrASEPARATE FORM FOR EACH CUISSIFICAT10rV
Permittee owner/Offlcer Name: EDDIE DONGHYUN PARK - DIRECTOR OF HIGHLAND FOODS CO., LTD
Email Address:
permittee Signature:
Wood.coAr
Date: �q' " -,)-o
ORC
Full Name: FREDERICK WEST Work Phone: [phone]
Email Address: [e-mail]
Certificate Type:
SI r Certificate Grade: N/A Certificateff: 1011888
Effective Date: 2 2
Signature:
sibie [barge j
7 rx-* that t agree to try des4ho ioa as the ror in Res w the fxilhY rested I understand and WE owe by the lido and rcgatatlats pe►tdnirg
to the r mwnstwltdas of the Was setiwth in and/ailing to doso can result in Dfsdp6nayAcdw+s by the WPC OX'
Backup ORC
JACOB TURNAGE Work Phone: [phone]
Full Name: 999705
Certificate Type: WW Certificate Grade: Select Certificate #:
Effective Date: oZ F �t7
Signature:
'1 certify that t ogree to Y awgr otion as the Operotar In Respond
Charge Jar the fadlhy noted ► uederstorrd and wNt abide by the raks and rcyulatlons pertainuty
to the responsibrlrries of the oRC as set forth in SSA NC4C OSG .0204 and falling to do so can resat in Mdplinary Acts by the WPC30Cr
k ORC
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Work Phone S, - _ S. S YJP
Full Name:
Certificate Type:
Select Certificate Grade: Select Certificate
2 `� %D
Effective Date:
Signature: in Responsible Cria a flit the fociBry I understand and wit abide by the ru and reguiadans
7 certify Thor r agree w y desipnotlan os the Open di+ rodo so can resat !n nra6or4rY Actions by the WPCSOCC'
pertaining W the responsibidties of the ORCas set forth in 15A NC4 LlBG.02U4 and/or g
Email this form to: [e-mail]
AND
Send to your DEQ Regional Office (send to your contact or find emalls here: www.deq.nc.goy/about/coritact/regional offices
or fax using this drop down Ilst:,Choose DWR Regional Office that has coverage of this faciliry.�F_,___
Uss dw Ltd pap ady if you nand to list addtdwW Backups.
Mviald oY2020