NC0005088_ORC Designation Form_20240923 (2)

WATER POLLUTION CONTROL SYSTEM OPERATOR DESIGNATION FORM
NCAC 15A 8G .0201
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Facility Name: Rogers Energy Complex Permit # NC0005088
Facility Type: WWQ Facility Grade: II 0 SUBMITA SEPARATE FORM FOR EACH CLASSIFICATION
Permittee Owner/Officer Name: Duke Energy Carolinas, LLC / Brandon K. Sipe
Email Address:
Permittee Signature:
dRC
Operator in Responsible Charge
Full Name:-Aore=p , agv 'd /^ivfl �� Work Phone: 6?2-0 Y1/1
Email Address:
Certificate Type: Select Certificate Grade: Select Certificate #: f 012Y3 f
Signature: Effective Date: ,
ify that I agree to my designation as the Operator in Responsible Charge for the facility noted. I understand and will
ide by the rules and regulations pertaining to the responsibilities of the ORC os set forth in 15A NCAC 08G .0204 and
failing to do so can result In DisciplinoryActions by the Water Pollution Control System Operators Certification Commission."
Full Name: Marty Rikard Work Phone: [phone]
Certificate Type: ww El Certificate Grade: Certificate #: 1014541
Signature: Effective Date:
certify that t4ree to my desVffa ' so Back-up Operator in Responsible Charge for the facility noted. I understand and will
abide by the rules and regulations pert ining to the responsibilities of the ORC os set forth in ISA NCAC 08G .0204 and falling to
do so can result In Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Full Name: Work Phone:
Certificate Type: WW 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 falling to do
so can result in DisciplinaryActions 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 COPYto: Choose DWR Regional Office that has coverage of this facility.
Revised 32mg