NC0089273_ORC Designation Form_20240930

Water Pollution Control System OPERATOR IN RESPONSIBLE CHARGE (ORC) Designation Form
NCAC 15A 8G .0201
TAB to Navigate Form
Facility Name: TRUIST FIELD - GW-REM, 324 S. MINT ST., CHARLOTTE Permit N NCO089273
Facility Type/Classilicalion: PC Facility Grade' I SUBMIT A SEPARATE FORM FOR EACH CLASSIFICATION
Permittee Owner/Officer Name: DBH Charlotte, LLC / Chirag Mithani
Email Address: cmithar iCwdiamondbaseballholdings torn
Permittee Signature: cit✓N
ORC
Full Name: Glenn Fredrick Price
Email Address: Glenn.PnceCd)uacelabs cam
Certificate Type: PC Certificate Grade: I
Date: ` 1 vb 12y
Work Phone i336i408-7924
Certificate #: 985800
Signature: ^_„�'�—��--_- ti _ _ Effective Date.
1 certify that) agree to my designorion as the Operator in Responsibiez argefarthefu iry noted rundersrand.r! w11 abate by the rotes and tequror�ons//perrnmmg
to the resp rs'bda'es of the ORC as serforfh m 15A NCACORa 0204and Julnng ro do W can reswt:n u1e,1mo1VACmm-h y the WpC50CL-
Backup ORC
Full Name: Baron Neal Meduffte Work Phone: [phone]
Certificate Type: PC Certificate Grade: I Certificate #: 987105
Signature: Effective Date:
-IM10 that l agree m my designonon os the Operator in the fanMynoted IaoCeerandond will abide by the rues andregalmrtn perWm,n;r
to the responsibildles of the ORCas set forth m 15A NCACORG 0104 and fndmg to do so Can resutr in OiurpbnnryArtont by the wPCSOCC'
Backup ORC
Full Name: Joel Schlaucit Work Phone: [phone]
Certificate Type: PC Ce ificate Grade I Certificate #: 1012069
Signature: Effective Date: 2,-aoay
-tcenify that toga" to my it, o" 'mope., etponvble Charge forth[ loohlyacted I understand and will abide by the mtes and regulations
perlairmg to the mspons,blblies of the ORt as set faith m IsA NG160RG 0204and jodrnp to do so Con lesuli r, 0lidplinory ACaons by/he WPCSOCC-
Email this form to: certadmin@deg nc.gov
AND
Send to your DEQ Regional Office (send to your contact or find entails here: www.deq.ne.gov/about/contact/regional offices
or fax using this drop down list. Moorasvtllu-610 F Cantor Ave, Suite 301, Mooteswlle, NC 26115 1 FAX. [phone] PH 704-663-'
Uu the 2ed page only If W. need to list additional Bac4aps
reewsc OV202a