NC0022187_ORC Designation Form_20241001

WATER POLLUTION CONTROL SYSTEM OPERATOR DESIGNATION FORM
NCAC 15A SG .0201
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Facility Name: GLOBAL COMPANIES CHARLOTTE NORTH TERMINAL Permit # NCO022187
Facility Type: PC Facility Grade: I SUBMITA SEPARATE FORM FOR EACH CLASSIFICATION
Permittee Owner/Officer Name: Tom Keefe
Email Address: TKeefe@glob�.com
Perm ittee Signature: to—ODate:
ORC
Operator in Responsible Charge
10/1 /24
Full Name:
Email Address:
Colin Parker Work Phone: [phone]
Colin. [e-mail]
Certificate Type:
PC Certificate Grade: I Certificate #: 996745
Signature:
Effective Date:
`I certify that I agree to my designation as the 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:
Austin Baker Work Phone: [phone]
Certificate Type:
PC Certificate Grade: I Certificate #: 1002045
Signature:
Effective Date: 91,30 J a0 ay
"I certi that I ogre e to my designation as a Back-up Operator in Responsible Charge for the facility noted. l understand and will
a ide by the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC OSG .0204 and failing to
do so can result in DisciplinaryActions 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 I FAX: [phone] [e-mail]
Mail or fax a COPY to: � Raleigh-3800 Barrett Dr.,Raleigh, NC 27609 1 FAX: [phone] PH: 919-791-4200 !
Revised 312019

Page 2
Facility Name: GLOBAL COMPANIES CHARLOTTE NORTH TERMINAL Permit #: NCO022187
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."
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."
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."
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 NC4COBG.0204 and jailing to
do so can result in Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."