NC0003417_ORC Designation Form_20241120

Water Pollution Control System OPERATOR IN RESPONSIBLE CHARGE (ORC) Designation Form
NCAC 15A 8G .0201
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Facility Name: Duke Energy Progress, LLC, H. F. Lee Energy Complex Permit # NCO003417
Facility Type/Classification: PC Q Facility Grade: I 0 SUBMITA SEPARATE FORM FOR EACH CUSSMUTION
Permittee Owner/Officer Name: Jeffery Hines, General Manager
Email Address: ,lette .clines aUKe-ever .corn
Permittee Signature: Q,14�
ORC
Date: // 1 Z?,,oLz�,v
Full Name: William M. Graham Work Phone: [phone]
Email Address: [e-mail]
Certificate Type: PC 0
Certificate Grade: I 0
Certificate #: 1003536
Signature: G✓�-i�— �m-�-� 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 falling to do so can result in Disciplinary Actions by the WPCSOCC'
Backup ORC
Full Name: James Patrick Herring Work Phone: [phone]
Certificate Type: PC 0 Certificate Grade: I 0 Certificate #: 1007920
Q
Signature: ({ Effective Date: / ( 1 2
'I certify that I agree to my designation as the Operator in Responsible Chaqi 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 1SA NCAC 08G .0104 and failing to do so can result in Disciplinary Actions by the WPOOCC'
Backup ORC
Full Name: Bradley Winston Mayhew Work Phone: [phone]
Certificate Type: PC 0 Certificate Grade: I 0 Certificate M 1011855
Signature: Lperator
/V _ Effective Date: 2iit
certify that I agree to m ign ion in Resp n 'ble Charge for the facility noted. I understand and will abide by the les nd regu ations
pertaining to the responsibilities f the ORC as setfarth In i5A C 08G .0204 and falling to do so con result 1n Disciplinary Actions by fhe 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 It you need to Ilst additional Backups.
Revised 02/2024

Facility Name: Duke Energy Progress, LLC, H. F. Lee Energy Complex Permit M NC0003417
Backup ORC
Full Name: Eric Hand Stroupe
Certificate Type: VWI 0 Certificate Grade: II
Work Phone: [phone]
Certificate M 990465
Signature: Ex.-c__ Effective Date: /I —/r-) -oq �-
'I certify that I agree to my designation as the Operator in Responsible Ch a 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 falling to do so can result in Disciplinary Actions by the WPCSOCC'
Backup ORC
Full Name: Work Phone:
Certificate Type: Select Certificate Grade: Select Certificate M
Signature: Effective Date:
'1 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 ISA NCAC 08G .0204 and falling to do so can result in DisciplinaryActions by the WPCSOCC'
Backup ORC
Full Name: Work Phone:
Certificate Type: Select Certificate Grade: Select Certificate M
Signature: Effective Date:
certify that 1 agree to my designation as the Operator In Responsible Charge for the fact ity noted. I understand and will abide by the rules and regulations pertaining
to the responsibilities of the ORC as set forth In ISA NCAC 08G .0204 and falling to do so can result in Disciplinary Actions by the WPCSOCC'
Backup ORC
Full Name: Work Phone:
Certificate Type: Select
Signature:
Certificate Grade: Select
Certificate M
Effective Date:
'1 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 ORCas setforth in 15A NCAC08G.0204 andfailing to do so can result in Disciplinary Actions by the WPCSOCC
Revised 02#2024