NC0005088_ORC Designation Form_20240923

WATER POLLUTION CONTROL SYSTEM OPERATOR DESIGNATION FORM
NCAC 15A 8G .0201
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Facility Name: Rogers Energy Complex Permit #
NC0005088
Facility Type: PC E Facility Grade: II SUBM?A SEPARATE FORM FOR EACH CLASSIFICATION
Permittee Owner/Officer Name: Duke Energy Carolinas, LLC / Brandon K. Sipe
Email Address: Cranaon.Sipe(N_Clulce-enerqy.com
Permittee5ignature: Date:
ORC
\ _ I Operator in Responsible Charge
Full Name: t7k Lm;j 1) J( Work Phone: gZrd y11'] Yr5,3-7
Email Address: o / t 41Cx e✓t cvuti
Certificate Type: Select Certificate Grade: Select Ce rtif icate #: i 0/2. �3 %
Signature: Effective Date: % y
rtify that 1 agree to my designation as the Opemtor In Responsible Charge far the facility note 1 derstand and will
abide by the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G .0204 and
0. foiling to do so can result In Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Backup ORC
Full Name: Trent Bailey Newton Work Phone: [phone]
Certificate Type: PC M Certificate Grade: 1
Certificate #: 1015294
Signature: �c��— Effective Date: (q/)LO/a c/
"1 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 con resultln Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Backup ORC ""
Full Name: Michael Charles Turner Work Phone: [phone]
Certificate Type: PC 7cate Grade: I Certificate #: 1015278
Signature: C�_ Effective Date: 91?b q
"I certify that I agree to my designation as a Bock -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 ORCos 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 orfax a COPY to: 'Choose DWR Regional Office that has coverage of this facility.
Revised a2019

Facility Name: Rogers Energy Complex Permit #:
Backup ORC
Full Name: Jonathan Kevin Butler
Certificate Type: PC 0 Certificate Grade: I
Page 2
NC0005088
Work Phone: [phone]
Certificate #: 1015287 4
Signature: Effective Date: V/A/,,2Y
"1 certify1othat I agree to Wgnation as a Bock -up 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 Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Backup ORC
Full Name: Work Phone:
Certificate Type: Select
Signature:
Certificate Grade: Select
Certificate #:
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."
Backup ORC
Full Name: Work Phone:
Certificate Type: Select 0 Certificate Grade: Select Q Certificate #:
Signature:
Effective Date:
"I certify that I agree to my designation as a Back-up 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 foiling to
do so can result in Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
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."