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WQ0029475_ORC Designation Form_20241106 (2)
Water Pallution CGntTol System OPERATOR IN RESPONSIBLE CHARGE 0 C) Designation Petra CAC 15A SG .020 7A 8 10 .$ lv kgat f xfn E ai1 Address: Certificate Type, t Certif sate Grade: : elc-ct V Certificate a: 448.2 Signature: Effective Date: Fo Mie sel 5 iA mw ay'� Lung � i:a € ab iY�' .4.�. c s's;a� 'r`.a_ i" suit Ae..;ts;F3 L; •;;�° -se'%<"fir Backup ORC 'UP Name Certificate i pe: Se? rCt 'r Signature: Work Phone: Certificate Grade: 11 Ir CeitifiCz'iti Gffectiva Date:. :o.Fw a op:, s.,-1 - ;' ti+r r 5a vcm {�' su dur. rrsctf a. ���ce tt"7�g lixi -sc§ vv 4i:Fesi,tcc, Backup ORC Eiiii arms: Wark P°r'owr . Certificate TVpe: O-lEct Certificate Grade- Sect ' certif(cate Signetwe: Effective mate: .l erP.�W��r 'cy cs to �'r tiES�Y;w-�s�a"r e; Lev ���,=�.«a r=r°;� yp,a�rsa�se : h�a- J E= ti:� � e�3• ���� � �r�, �, yt e, % SLmd to Your DEQRegianati Office Isen % Dui CQlta,,:t r '-rid ii" fay = ng "1i< u U rop c�93tR ; [r �'t 32 Y t futi --l! lJi 1 3 4 S ; ''AY, . 91,0• Ph g?.) Olt tht Nid N19t [pity gf YOU rteeO 9DLJ, M2.