NC0046213_Operator Designation_20180810

Water Pollution Control System Operator Designation Foff&EIVEDiNCDENRIDWR
WPCSOCC A%Ir I into
NCAC I SA 8G .0201
Permittee Owner/Officer Name: Angela Brown wORGI
M80.4ESa/,L�C-fFE-610NAL OFFICE
Mailing Address: 539 South Main Street
City: Findlay State: 011 Zip: 45840
Email address:
Signature:
Phone #: [phone]
Date: K- O- 1O
..........................1.y..............................................................................................................
Facility Name: MPLX Terminals LLC - Charlotte West "Terminal Permit #: N0004621
County: Mecklenburg
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SUBMIT A SEPARATE FORM FOR EACH TYPE SYSTEM!
Facility Type/Grade (CHECK ONLY ONE):
Biological Collectionsical/Chem' 1 Surface Irrigation Land Application
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Operator in Responsible Charge (ORC) *Please remove Terry Swiek as ORC
Print Full Name: Darryl Keith Thompson Email: [e-mail]
Certificate Type / c ut ber: PC / I / 1005070 Work Phone #: [phone] �y
Signature: X Date:
" I cenit'y that I agree to niy dl. ignatinn as the Operator in Responsible Charge for the facility noted. I understand mid will abide by the rules
and regulations pertaining to the responsihilities of the URCas set forth in 15A NC'AC 08G .0204 and failing to do so can result in Disciplinary
Actions by the Water Pollution Control System Operators Certification Commission:'
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Back -Up Operator in Responsible Charge (BU ORC)
Print Full Name: Terry James Pridgen, Jr. Email: TEPridgenrdMarathonPetroleum.cont
Certificate Type/ tirade / Number: C / 1 / 1004617 Work Phone #: [phone]
Signature: X _ /� Date: g /Z 12401S
" I certilk that I agree to my designation as u Back-up (llferator in Responsible Charge for the facility noted. I understand and will abide by the
rules and regulations pertaining to the responsibilities of the Bl) ORC us set forth in 15A NCAC 08G .0205 and tailing to do so can result in
Disciplinary Actions b) the Water Pollution Control System Operators Certification C ommission.-
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Alail, firs or emall Ate W PCSOCC, 1618 Mail Service Center, Raleigh, NC 27699-1618 Fax: 919.715,2726
ortzhi to: Email: certadmiWa—mcdenr.gov
Alall or fav a cape to the Asheville
Fayetteville
Mooresville
Raleigh
appropriate Regional Ogee: 2090 (IS Hwy 70
225 Green Sit
610 8 Center Ace
3800 Barren Dr
Ssrannanoa 28778
Suite 714
Suite 301
Raleigh 27609
Fax: [phone]
Fayetteville 28301.5043
Mooresville 28115
Fax: [phone]
Phone: [phone]
Fax: [phone]
Fax: [phone]
Phone:[phone]
Phone: [phone]
Phone: [phone]
Washington
Wilmington
Winston-Salem
943 Washington Sy Mall
127 Cardinal Or
450 W. Hanes Niall Rd
Washington 27889
Wilmington 28405-2845
Winston-Salem 27105
Fax: [phone]
Fax: [phone]
Fax: [phone]
Phone: [phone]
Phone: [phone]
Phone: [phone]
Revised 05-2015