NC0004979_ORC Designation Form_20221121 (2)

WATER POLLUTION CONTROL SYSTEM OPERATOR DESIGNATION FOR r
'heNCAC 15A 8G .0201 G
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Facility Name: Plant Allen Steam Station Permit# NC0004979
.FCEIVED/NCDE O/DWR
Facility Type: PC F] Facility Grade: II SUBMITA SEPARATEFORMFOR EACH CLASSWICATION
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Permittee Owner/Officer Name: Jeffrey Flanagan bVOROS
Email Address: [e-mail] i I LE REGIONAL OFFICE
Permittee Signature: r 11 l 4v I^26��
Date: l
ORC
Operator in Responsible Charge
Full Name: Joshua Layne Calhoun Work Phone: [phone]
Email Address: [e-mail]
Certificate Type: PC— 0 Certificate Grade: II 0 Certificate#: 1012355
Signature: �) , ✓ ,��.�,�_ Effective Date:
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"/cer y that/agree to desi ation as the Operator in Responsible Charge for the facility noted. I understand and will
abi y 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 Water Pollution Control System Operators Certification Commission."
Backup ORC
Full Name: Michael R Gantt Work Phone: [phone]
Certificate Type: PC 0 Certificate Grade: II
Certificate#: 1004850
Signature: C , z Effective Date: /L//
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"I certify that/agree to my designation as a Back-up 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 Water Pollution Control System Operators Certification Commission."
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 a Back-up 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 Water Pollution Control System Operators Certification Commission."
Mail,fax or email ORIGINAL to: WPCSOCC, 1618 Mail Service Center, Raleigh, NC 27699-1618 1 FAX:[phone] [e-mail]
Mail or fax a COPY to: Mooresville-610 E. Center Ave., Suite 301, Mooresville, NC 28115 1 FAX: [phone] PH: 704-663-1699
Revised 312019