NC0000396_ORC Designation Form_20241008

Water Pollution Control System OPERATOR IN RESPONSIBLE CHARGE (ORC) Designation Form
NCAC 15A 8G .0201
TAB to Novigote Farm
Facility Name: Asheville Combined Cycle Station Permit # NCO000396
Facility Type/Classification: PC E] Facility Grade: I E SUBMIT A SEPARATE FORM FOR EACH CLASSIFICATION
Permittee Owner/Officer Name: Keith Douthit
Email Address: [e-mail]
Permittee Signature: '��--�iC� Date:
ORC
Full Name: Teresa Williams
Work Prone: [phone]
Email Address: [e-mail]
Certificate Type: PC Certificate Grade:
Certificate #: 1005058
�.>���
Effective Date:'
Signature: W
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 WPCSOCC"
Backup ORC
Full Name:
Work Phone:
Certificate Type: Select Certificate Grade: Select
Certificate #:
Signature:
Effective Date:
"I certify that 1 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 WPCSOCC"
Backup ORC
Full Name:
Work Phone:
Certificate Type: Select Certificate Grade: Select
Certificate #:
Signature:
Effective Date:
"I certify that 1 agree to my designation us 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 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/regional-offices
or fax using this drop down list: Choose DWR Regional Office that has coverage of this facility.
Use the 2nd page only if you need to list additional Backups.
Revised 0212024

Water Pollution Control System OPERATOR IN RESPONSIBLE CHARGE (ORC) Designation Form
NCAC 15A 8G .0201
TAB to Navigate Form
Facility Name: Asheville Combined Cycle Station Permit # NC0000396
Facility Type/Classification: PC E Facility Grade: I SUBMITA SEPARATE FORM FOR EACH CLASSIFICATION
Permittee Owner/Officer Name: Keith Douthit
Email Address: [e-mail]
Permittee Signature:'��� Date:_
ORC
Operator in Responsible Charge
Full Name: Teresa Lynne Williams
Email Address: [e-mail]
Work Phone: [phone]
Certificate Type: PC Certificate Grade: I
Certificate #: 1005058
Signature:
Effective Date:
"1 certify that i agree to my designation as the Operator in Responsible Charge for the facility noted,
l 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 WPCSOCC"
Backup ORC
Full Name: Dana Newcomb
Work Phone: [phone]
Certificate Type: PC Certificate Grade: I
Certificate #: 989611
1
Signature: I ..•
Effective Date: L.':q2 9
"l certify that 1 agree to my designation as the Operator in Responsible Charge for the facility noted.
! 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 WPCSOCC"
Backup ORC
Full Name:
Work Phone:
Certificate Type: Select Certificate Grade: Select
Certificate #:
Signature:
Effective Date:
"1 certify that 1 agree to my designation as the 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 setforth in 15A NCAC 08G.0204 and failing to do so can result in Disciplinary Actions by 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/regional-offices
or fax using this drop down list: Asheville-2090 US Hwy 70, Asheville, NC 28778 1 FAX: [phone] I PH: 828-296-4500
Use the 2nd page only if you need to list additional Backups.
Revised 1112023

Facility Name: Asheville Combined Cycle Station Permit#: NC0000396
Backup ORC
Full Name: Neil Attaway Work Phone: [phone]
Certificate Type: PC Certificate Grade: I El Certificate #: 1015770
Signature: Effective. Dale; �� 1 t
1 certify that agree to my de ignation as the. Opera r ' Responsible Charge for the facility noted. ! understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORC as set forth in 15A N AC 08G.0204and.failing to do so can result in Disciplinary. Actions by the WPCSOCC'
Backup ORC
Full Name: Work Phone:
Certificate Type Select Certificate Grade: Select Certificate #:
Signature: Effective Date:
`? certify that 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 WPCSOCCN
Backup ORC
Full Name: Work Phone:
Certificate Type: Select. Certificate Grade: Select Certificate: #:
Signature: Effective Date:
"/ certify that i agree to my designation as the Operator in Responsible Charge far the facilitynoted. 1 understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORC as set forth in 15A NCAC 08G d1204 and failing to do so can result in Disciplinary Actions by the WPCSOCC"
Backup ORC
Full Name:
Work Phone:
Certificate Type: Select Certificate Grade: Select Certificate #:.
Signature: Effective Date:
"i certify that! agree to my designation as the Operator in Responsible Charge for the facilitynoted. 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 WPCSOCC
Revised 0?/2024

Facility Name: Asheville Combined Cycle Plant
Permit #: NCO000396
BACKUP ORC
Print Full Name: Christian Patterson Work Phone:[phone]
Certificate Type: PC
Certificate Grade
Email Address: [e-mail]
Certificate #: 1010232
Page 2
Signature: (__� Effective Date: 61 1' 20 ZZ
"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
Print Full Name: Work Phone:
Certificate Type: Select Certificate Grade: Select Certificate #:
Email Address:
Signature: Effective Date:
"I certify that/ 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 failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
BACKUP ORC
Print Full Name: Work Phone:
Certificate Type: Select Certificate Grade: Select Certificate #:
Email Address:
Signature: Effective Date:
"I certify that/ 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 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
Print Full Name: Work Phone:
Certificate Type: Select Certificate Grade: Select Certificate #:
Email Address:
Signature: Effective Date:
`7 certify that I agree to my designation as a Back-up Operator in Responsible Charge far the focility 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."
Revised 512019