NC0066362_ORC designation and signature authority._20170427

APR-27-2018 13:21 From:Postaee Express 828 698 7555 To:2997043 Paee:112
Wastewater Brch
Water Qualityermitting Section
Division of Wa er Resources
1617 Mail Sery .ce Center
Raleigh, NC 27699-161I7
Subject: Pelegatign of Signature Authority
Number NC i�1L 40loCa��
To Whom It
By notice of tb3 s letter, � hereby delegate signatory authority to each of the
permit avpplicatlons, discharge monitoring reports, and other information re
the subject faci 'ty as rewired by all applicable federal, state, and local en)
specifically Witt the regpuements for signatory authority as specified in 1
Individual #1
ling individuals for all
to the operations at
ental agencies
AC 213.0506.
d #2 (fappucabie)
Name:pQIL
So�CS
Title:
D t2G
----
MailingAddr
s:
Physical Addre
frfd*rew>
s:
Email Address:
�� 6� ur " wa•A . cor
Office Phone:
$2
- SSI - 11 b Z--
- -
Mobile Phone:
gLg
- Z-11 - o vD
- -
If you have an quesiioils regarding this letter, please feel free to contact me Enter Email or Phone
Number.
Sincerely,
Authorized S" aing Official's Name N`pl/�/7
Authorized Si isg Official's Title 0 ✓ -0 AJC S91
Mailma Addressitl4 d 0R O M� �' So I t-F�t
Email Address r a`FhiniJ2l>�r%
Office: Phone
Mobile Phone
cc: ofk,Regional Office, Water Quality Permitting Section

APR-27-2018 13:21 From:Postaee Express 828 698 7555 To:2997043
Water Po -\ .in Control System Operator I l„n toa
Form
WPCSOCC
NCAC 1SA 8G .0201
Perarittee Owne77or
Mailing Addrrss:
City: (r1{ Cajk4, l-fc
Email address:
Signature: t cn
FaeHityNemc_ lq
Operator in Resi
Print Full Name:
Certificate Type /
Signature:
"I certify that I agree to
and regulations pulaw
...........................
Back -Up Operator
Print Full Name:
Certificate Type /
Signature: T�-
"I certify that I agree I
rules and regulations I
Disciplinary Acorn 1
nnial to:
Mail orfaea cony to
appropriate Regi ndl
at Zip:-094 .
Phone#:
Date:q.- a5-j
Paee:212
Nc, Doi aDs (0a
UT A SEPARATE FORM FOR EACH TYPE SYS't E, MI
Facility 1y+pe/Grade (CHECK ONLY ONE):
tion Physical/Chemical Surface Ir7igation Land Appl
(ORC)
rl _)or6� F.rnnil- 1`7'IfatloS or;a,,d c'v,%AJ•Go
Work Phone#• f 2
i dcailnatihn as the operator in Responsible Charge for the facility note& I underal
VOL the responsibilities of the ORC as sct fortb In 15A NCAC 08G .0204 and Wrung
Ilion ContSpl Syhlem Operators Certification Commission."
............I...........................................................................
't Respoaible Charge (BU ORC)
-aUOC e1lll.... MGhn' r{n Email- If Z. ilef C rh e) 4)9
IN tier: t o w 2 I s $�---_.. Work Phone #: 9 L/
4� Date:
signatibn as a Back-up Opwator in Responsible Charge for the facility noted. I
g to" responsibilities of 0te RU ORC m set forth in 1SANCAC 08G .0205 a
Ater Foution Cbnhol System Opeators Certification Commission."
�.... ...... . ...........................................
VPCSt7CCr 1618 Mao Service Center, Riteigh, NC 27699-
us Hwy 70
in inea 28778
828.299.7W
x: 82
hington
Washington Sit Wall
tington 27889
252.946.9215
te: 252946.
Fayetteville
225 Groom St
Suite 714
Faycitcvllc 28301-5043
Fax: 910A86.0707
Phone: [phone]
Wilmington
127 Cardinal 1lr
Wilmington 28405-2845
Fax: 910.3S0.2004
Phonic: 910.796.7215
Mooresville
610E Center
Snilc 301
Mooresville
F=: 704.6&
Phony. 704.,
450 W.
winsta
Fut 3_
Phone:
7-?3'0-7Go
(1 g
and will abide by the rules
o so can result in Disciplinary
dmstand and will abide by the
failing to do so can result in
518 Fak:919.715.2726
italeigh
We
3800 Barrett Dr
Raleigh 27609
ills
Faa-919SUA718
$040
Phoae.919.791A200
3.1699
m
Mall Rd
127105
/797
'6.9800
Revised 05-2015