NC0089435_ORC Designation Form_20241002

Water Pollution Control System OPERATOR IN RESPONSIBLE CHARGE (ORC) Designation Form
NCAC 15A 8G .0201
7AB to Navigate Form
Facility Name: Martin County WTP
Permit# NCO089435
Facility Type/Classification: PC Q Facility Grade: 1 Q SUBMITAsEPARATEFORMFOREAcHaASSIFI[47foN
Permittee owner/Officer Name: Martin County Regional Water and Sewer Authority/Julius Patrick Chair _
Email Address:
Permittee Signature:
ORC
Date: 7­,?o -ay
Full Name: Cody Craft Work Phone: [phone]
Email Address: [e-mail] _..
Certificate Type: PC Certificate Grade: I Certificate#: iui5,Xa3
Signature: Effective Date: 1.010V
to the nespoouagree to th de ssetfo thI Opemtorin Responsible Chmpe/ortheso ma noted. lhatelk mMctions l Me 6y Ne roles and rtpubeons pertalnlnp
to the responsibilRies of the ORC as setJorth In 35ANCA[08G D2o1 and/aillnp [o da so wnresultin DlsdylNoryAcaom bYdIeWRCSpCc-
Backup ORC
Full Name:
Julius Patrick
Work Phone: [phone]
Certificate Type: PC S' Certificate Grade: I 0 Certificate#: 996041
/
Signature: / 2j , j -- Effective Date: )Q - ) - 'a 9
'l certiiY [hotl agree to mY desnon as Me Operatorin Responsible ChoMefer thefocniynotM. Iundentundondwyl ubWbyMervlesoMr,p lationsp mining
totheresponslMtlesojthe ORip assetforthi li Nf CM6.O2 Candfailingrodos wnmsultin Duciplinory Act bythe Wy "CC
Backup ORC
Full Name:
Work Phone:
Certificate Type: Select Certificate Grade: Select Certificate
Signature: Effective Date:_
9ceneing ba hereeromydthesootian ns[he Dperotar in Resppnsble Cholge4.ndfJudhty noted lnlesohtondond wla,Aawsby ry WPC50Cgulotlons
pertpininp ro the resyonsidlitles of the ORC as selJorth in ISA NCACDBG.02W and/pigng fa tlo so con resuh in ahcipllnary ARionsby the WPCSOCC
Email this form to: [e-mail]
AND
Send to your DEQ Regional office (send to your contact or find emails here: www.deq.nc.gov/about/contact/regionalroffices
or fax using this drop down list: Washington-943 Washington Sq. Mall, Washington, NC 27889I FAX: [phone] PH: 252-346-6M
use the Ind page only If you need to IM addidon d aaebups.
ReWed MO24