NC0034959_Delegated Authority_20141020

October 10,2014
RECEIVED/DENRIDWR
Wastewater Branch 0 C T 2 0 `L u t a
Water QualityPermitting Section
Division of Water Resources Water uuatity
rola'7 Mail Service Center Permitting Section
Raleigh,NC' 27699-1617
Strbjeett Delegation of Signature Authority
West Rowan High School
NPDES Number NC0034959
To Whom It May.Concern:
By notice of this letter, I hereby delegate signatory authority to each of the following
individtiials for at permit applications,discharge monitoring reports,and other information
relating to the operations at.West Rowan High School as required by all applicable federal,
states and local environmental agencies specifically with the requirements for signatory
authority as specified in 15A NCAC 23.0506.
Name Title
Jody Blythe Wells Pesticide
if you have any questions regarding this letter,please feel free to contact me at.
Sincerelly„
>!
Dr E nn Moody
Superintendent
cc: Mooresville Regional Office,Water Quality Permitting Section

October 10;2014:
, Wastewater•Branch
•
Water Qttality Permitting.Section
,,,, lvision of'Water Resources
:11017.144111 Service_Center
Raleigh,.NC 27699-1617
Subject: Delegation of Signature Authority
West Rowan High School
NPDES Number NC0034959
To Whom h May Concern:-
By
oncern:By. notice:of this. letter, I hereby delegate signatory authority to each of the following
individltalt&rail permit applications,discharge monitoring reports,and other information
relating to,the operations at.West Rowan High School as required by all applicable federal,
stater and local environmental agencies specifically with the requirements for signatory
authority as,specified in 15A NCAC 2B.0506.
Name Title
Jody Blythe Wells Pesticide
1`f youu have,any questions regarding this letter,please feel free to contact me at.
Sincerely,.
, At-0'V—
Dr: . n,*Moody
Superintendent
cc:: Mooresville.Regional Office,Water Quality Permitting Section

r
Submitter Change Request Form—(4dd/update users)
North Carolina Electronic Discharge Monitoring Report System
Stki 9U491 @a%bet gitiQuAtuts
EDMR registered Owners may use this form to add or update eDMR users to the NCDWR's Electronic
Discharge Monitoring Report system. If the Organization is not currently registered for eDMR,then the
Owner or designated Responsible Official will need to complete the required eDMR Registration Form
(available from the eDMR website)and submit it to the NCDWR eDMR Administrator at the address
below.
Type of Request(please select): RECEIVEDIDENRIDWR
X Add Submitter Permissions: (See Section B) OCT 2 ()
Update Submitter Permissions: (See Section B)
Wates Sector
add or update eDMR user permissions,please provide the following information: Per► 9
Section A: Owner Information
NPDES Permit Number: NC0034959
Owner/Organization Name: Rowan-Salisbury Schools
Responsible Official
(us identfed in accordance with 4Q(PR 122.22) B.H. Bivens
Street Address: 8050 Nc Hwy 801
City: Salisbury
State/Zip Code: NC 28125
Telephone number: (704 ) 8573400
E-mail address: [e-mail]
Section B: Activate New Submitter or Update Existing User
Please complete the Submitter User Details on page 2 for the individuals who will need Submitter
permissions or to update Submitter details,such as adding additional permits,to an existing user.
Submitter permissions can only be assigned by the NCDWR eDMR Administrator. Note: Tire Owner
and Facility Administrator can deactivate or delete eDMR user permissions for any individual within
Its organization,including Submitter permissions.
The Submitter is equivalent to the individual who signs the certification statement on the back of the
Discharge Monitoring Report. The Submitter must be an individual with delegated signatory authority
for the Owner/Organization. If individuals other than the Responsible Official for the Owner have been
delegated signatory authority,the Division of Water Resources must be notified in writing of such
delegations. A delegation of authority form is available from the eDMR website.
In addition to the User Details,please specify the NPDES permit(s)that each user will be associated with
for eDMR submittal. Should additional space be needed for users and/or permits,please make additional
copies of the Submitter User Details page and complete as needed.
NCDWR eDMR Submitter Change Request Form-ver.1.0 Page 1

Submitter User Details
Permit No.(s): NC0034703 NC0034959
•
First Name: Jody
Middle Name:
Last Name: Blythe
Phone Number: (704) 8573400
Email: blythe)[e-mail] User ID:
(Assigned bLNCDWR eDMR Administrator)
'Selleetkegstest. (2 Add User Permission
Type: 0 Update User Permission Add/Update User Permission as of(Date):
Submitter User Details
Permit No.(s):
First Name:
Middle Name:
Last Name:
Phone Number: ( )
Email: User ID:
(Assigned by NCDWR eDMR Administrator)
Select Request 0 Add User Permission
Type: 0 Update User Permission Add/Update User Permission as of(Date);
Submitter User Details
Permit No.(s):
First Name:
Middle Name:
Last Name:
Phone Number: ( )
Email: User ID:
(Assigned by NCDWR eDMRAdminlstrntor)
Select Request 0 Add User Permission
Type: 0 Update User Permission Add/Update User Permission as of(Date):
NCDWR eDMR Submitter Change Request Form-ver.1.0 Page 2

Submitter User Details
Permit No.(s): NC0034703 NC0034959
RECEn/EpDENRIDWR
First Name: Jody
Middle Name: OCT 2 0 1 u 14
Last Name: Blythe Water t.lua_ ut�l_
Phone Number: (704) 8573400 Permitting n
Email: [e-mail] User ID:
(Assttned by NCDWR eDMR Adatlnlstrater)
Select Request- IR Add User Permission
TyPe 0 Update User Permission Add/Update User Permission as of(Dau):
Submitter User Details
Permit No.(s):
First Name:
Middle Name:
Last Name:
Phone Number: ( )
Email: User ID:
(Assigned by NCDWR eDMRAdministrator)
Select Request 0 Add User Permission
ThPer 0 Update User Permission Add/Update User Permission as of(Date):
Submitter User Details
Permit No.(s):
First Name:
Middle Name:
Last Name:
Phone Number: ( )
Email: User ID:
_ (Assigned by NCDWR eDMR Adwmli dstnuer)
select Request 0 Add User Permission
TyPe: 0 Update User Permission Add/Update User Permission as of(Date):
NCDWR eDMR Submitter Change Request Form-ver.1.0 Page 2

Responsible Official Authorization
The Responsible Official,as identified in accordance with 40 CFR 122.22,is the appropriate individual
with the authority to sign reports for the organization.
1, Dr. Lynn Moody (printed name),have the authority to make this request for
Rowan-Salisbury Schools (Owner/Organization Name).
I request the NCD.WR add or update the eDMR Submitter user permission(s)as indicated above on the
Submitter User Details page.
0c..ri nic..�ch /0 - /) - / yOwner/ ponsible Official Sig ture Title Date
Please return the completed form to the NCDWR eDMR Administrator via:
Fax: or E-mail: or Mail to:
[phone] [e-mail] Information Processing Unit
Attn: eDMR Registration
1617 Mail Service Center
Raleigh,NC 27699-1617
NCDWR eDMR Submitter Change Request Form-ver.1.0 Page 3