NC0034754_Other Correspondence_20190530

COMMSCOPE
O
14
6519 CommScope Road
MAY 3 1 ;, 91 Catawba, NC 28609
www.commscope.com
WQROS
May 30, 2019
Wes Bell
NCDEQ
610 East Center Avenue, Suite 301
Mooresville, NC 28115
704-663-1699
Subject: CommScope, Inc.- WWTP
NPDES Permit number NC0034754
Dear Wes:
Please find enclosed a copy of the Delegation of Signature Authority and Electronic Signature
Agreement as submitted to NCDEQ- Raleigh for the CommScope WWTP located at 6519
CommScope Road, Catawba, North Carolina.
Please feel free to contact me at 828-241-6037 with any questions.
Sincerely,
Laura R. Moody
Senior Environmental Engineer
Office phone: [phone]
Cell phone: [phone]
[e-mail]
cc: NCDEQ, Central Files

May 29, 2019
Wastewater Branch
Water Quality Permitting Section
Division of Water Resources
1617 Mail Service Center
Raleigh, NC 27699-16f7
Subject: Delegation of Signature Authority
COMMSCOPE CATAWBA WWTP
NPDES Permit Number NCO034754
To Whom It May Concern:
By notice of this letter, I hereby delegate signatory authority to each of the following individuals for all
permit applications, discharge monitoring reports, and other information relating to the operations at
the subject facility as required by all applicable federal, state, and local environmental agencies
specifically with the requirements for signatory authority as specified in 15A NCAC 2B.0506.
Individual #1.
Individual #? ar"nnlinnhl�l
am
Jeff Phillips
Nicole Johnston
N'1tle
EHS Manager
Consultant
r
Malhng Address
6519 Commscope Road'
6519 Commsco e Road
p
Catawba, NC 28609
Catawba, NC 28609
[e-mail]
828 - 241 - 6039
828 - 612 - 1396
[e-mail]
N/A - -
336 - 366 - 0870
If you have any questions regarding this letter, please feel free to contact me at
[e-mail] and 828-241-6039.
Sin erely,
Dayne Willis
6519 Commscope Road
Catawba, Nc 28609
[e-mail]
828-241-6355
cc: Mooresville Regional Office, Water Quality Permitting Section

111.C. Department of Environmental Quality
Division of Water Resources
Electronic Signature Agreement
Federal regulations require that electronic documents must have valid electronic signatures if Title 40 of
the Code of Federal Regulations requires handwritten signatures on the paper documents they replace.
Valid electronic signature refers to an electronic signature on an electronic document that has been
created with an electronic signature credential.
This, Electronic Signature Agreement, when finalized and approved, will allow the individuals with
electronic signature credentials to sign electronically a variety of required permit documents in lieu of the
submittal of signed paper copies. The submittal of Electronic Discharge Monitoring Reports (eDMR)
will be available once your electronic signature credentials are in place. Some agreements for document
submittals or acceptance, as noted in the Agreement Conditions (Section B.), are not currently available
electronically but are included here to have the agreements in place and to avoid the need to complete
future submittal of agreement forms when these systems are initiated.
A. Owner / Organization Information
ttrvner/Qr ariization-l\1ame; "``
CommSco e- Catawba
Itespousible U cla =
xr
Dayne Willis
as rd�ntified in accordancewith 4(3 CFTL 122 22
v
Sheet Address
6519 CommSco e Road
Catawba
NC 28609
P][tine plumber,' ;>
828 241-6000
Email Address, ti
Dwillis@commscope coin
*ea>tyaxt wall ts� the pntttary methtri of eentaef forthe=elestmna� ;;
sabip�tfal proge s so at is inapot 3o hates accufate
`table
av at al times. .
B. Agreement Conditions
To receive and accept the required electronic signature credential, consisting of a user name and
password, issued by the North Carolina Division of Water Resources (NCDWR) in order to sign
electronic documents submitted to NCDWR's Electronic Document Systems and to receive electronic
documents from NCDWR's systems;
The Responsible Official and Submitter (if applicable) named in this form do herby:
1. Understand that this Electronic Signature Agreement requires me to submit electronic documents to
NCDWR's approved eDMR system under the authorized program in lieu of paper submissions.
2. Understand that this Electronic Signature Agreement requires me to accept electronic transmissions,
in lieu of paper transmissions of all permits, permit modifications, authorizations to construct, and
any other correspondence related to reviewing and processing permits from NCDWR. This
authorization will not become effective until NCDWR establishes a system for processing electronic
documents; I am notified in writing from NCDWR that use of the electronic systems has officially
been initiated; and North Carolina rules and statutes are changed to allow the implementation of
electronic submittal and acceptance of documents.
NCDWR Electronic Submittal Agreement Version 1 Page 1

Understand that this Electronic Signature Agreement requires me to submit electronic all necessary
information for processing of NPDES application including information for renewal of existing
permits, modification to existing permits, and applications for new discharge permits. The submittals
may include all necessary applications and supporting documentation to NCDWR's approved system
for electronic submittals in lieu of paper submissions. This authorization will not become effective
until NCDWR establishes a system for processing electronic documents; I am notified in writing from
NCDWR that use of the electronic systems has officially been initiated; and North Carolina rules and
statutes are changed to allow the implementation of electronic submittal and acceptance of
documents.
4. Understand that this Electronic Signature Agreement requires me to accept electronic submissions, in
lieu of paper submissions, of all Notices of Deficiency, Notices of violations, Civil Penalty
Assessments, and any other correspondence related to compliance with federal and state water quality
laws and regulations that might be sent by NCDWR. This authorization will not become effective
until NCDWR establishes a system for processing electronic documents; I am notified in writing from
NCDWR that use of the electronic systems has officially been initiated; and North Carolina rules and
statutes are changed to allow the implementation of electronic submittal and acceptance of
documents.
5. Agree to protect both the electronic signature credential, consisting of my user nameand password,
and security questions and answers, from compromise and from use by anyone except me.
Specifically, I agree to maintain the secrecy of my electronic signature credential and security
questions and answers; I will not divulge or delegate my credential or security questions and answers
to any other individual; I will not store my credential or security questions and answers in an
unprotected location; and I will.not allow my electronic signature credential or security questions and
answers to be written into computer scripts to achieve automated log -in.
6. Understand and agree that I will be held as legally bound, obligated, and responsible for the use of my
electronic signature as I would be using my hand-written signature.
7. Understand that I will be informed through my registered email address whenever my user name or
password has been modified.
8. Understand that eDMR reports the last date my user name and password were used immediately after
successfully logging into eDMR.
9. Agree to contact the NCDWR eDMR Administrator via email at el)MRadmin(a)ncderu Gov as soon
as possible, but no later than 24 hours, after suspecting or determining that my user name and/or
password have become lost, stolen or otherwise compromised.
10. Agree that I will review the contents of all electronic submissions prior to submission.
11. Understand that I will automatically receive an email receipt at my registered email address from the
NCDWR's eDMR system for any submission that contains a valid electronic signature, identifying
the document received, the signatory, and the date and time of receipt.
12. Agree to contact the NCDWR eDMR Administrator via email at eDNlRadmin a)3�cdc new if I do not
receive an email receipt as specified above within five (5) business days for any electronically signed
submission using my credentials.
13. Agree that if I received an email notification for an activity that I do not believe that I performed, I
will notify the NCDWR eDMR Administrator via email at eD.MRadi.iainLc)ncdenr gov as soon as
possible, but no later than 24 hours, after receipt.
NCDWR Electronic Submittal Agreement Version 1 Page 2

14. Agree to report, within 24 hours of discovery, any evidence of discrepancy between any electronic
document I have signed and submitted and what the NCDWR eDMR has received from me by
contacting the NCDWR eDMR Administrator via email at eDMR.adniin@ cderir gov.
15. Understand that the NCDWR eDMR's system will automatically reject any electronic document
submitted without a valid electronic signature if such signature is required.
16. Agree to contact the NCDWR eDMR Administrator via email at eDMRadmin@)ncdenr gov within
ten working days if my duties change and I no longer need to interact with eDMR on behalf of my
organization.
17. Agree to notify the NCDWR eDMR Administrator via email at eD.MRada.n.ink)ncdenr tlov if I cease
to represent the regulated entity specified above as signatory of that organization's electronic
submissions as soon as this change in relationship occurs.
18. Understand that the NCDWR may contact the Organization's Responsible Official, who signs below
to authorize me as a signatory for the Owner/Organization, in order to verify my identity.
19. Agree to retain a copy of this signed agreement as long as I continue to represent the regulated entity
specified above as signatory of the Organization's electronic. submissions.
20. Certify that I have the authority to enter into this Agreement on behalf of the Organization identified
above, and I am a signatory authorized to represent that Organization, and I am able to sign and
submit reports and other information on behalf of that Organization in the capacity required by statute
and/or regulation.
C. Permit/Facility Information
Approval under this Electronic Signature Agreement is applicable to the following permits and if
applicable to the Submitters, if noted here and in Section E:
NC0034754
CommScope- WWTP
p
6519 CommScope Road
Catawba, NC 28609
Dayne Willis
NC0034754
CommScope- WWTP
p
6519 CommScope Road
Catawba, NC 28609
Jeff Phillips
NC0034754
CommScope- WWTP
6519 CommScope Road
Catawba, NC 28609
Laura Mood y
NC0034754
CommScope- WWTP
p
6519 CommScope Road
Catawba, NC 28609
Mark Carpenter
NC0034754
CommScope- WWTP
p
6519 CommScope Road
Catawba, NC 28609
—
Nicole Johnston
t Vnn may nnh, in,1-4o r.— +� ....., . A ...:,L n_- ----' -- rr
- - .- ---- _.».--....... — .......... ........a. Yaw is nuuucu for auunionai permits or submitters you
may attach separate pages. A supplemental sheet is available at: httns:Hdea.ne. _ov/about,<livisions/water
l:csources/e<,_mr/#grin s-t�ttcl,-relc�t�ts
2. A separate Section E must be included for each Submitter in order to obtain a hard copy signature and notarization for all
entities. If more than one individual will have submitter permissions for the same permit, then indicate this on separate
rows.
NCDWR Electronic Submittal Agreement Version 1 Page 3

D. Responsible Official
The Responsible Official, as i
with the authority to sign and
I, Davne Wil
this Agreement for
d in accordance with 40. CF R J 2122, is the appropriate individual
reports for the organization.
(printed name), have the authority to enter into
(Owner/Organization Name).
I request the NCDWR grant me andy if included in Sections C and E of this form, the named Submitter(s),
an electronic signature credential to!submit and accept documents electronically on behalf of my
organization. !
I acknowledge that I, and the individual(s) named in Sections C and E (if applicable), work at/for my
organization and have authority to submit and accept electronic documents and act as a signatory for
purposes of the NCDWR's electronic document systems.
By submitting this application, I, I Davne Willis (printed name), have read,
understand, and accept the terms and conditions of this Electronic Signature Agreement. I certify under
penalty of law that I have personally examined and am familiar with the information submitted in this
application and all attachments and that, based on my inquiry of those persons immediately responsible
for obtaining the information contained in the application, I believe that the information is true, accurate
and complete. I am aware that there are significant penalties for submitting false information, including
the possibility of fine and imprisonment.
h�f4 r - 1)
P��-�,�s l�..lrr4�,r S
R4one Official Signature Title Date
DwillisAcommscope com 828 241-6355
Email Address Phone Number
*email will be the primary method of contact for the electronic submittal process so it is important to have an accurate email
available at all times
If you are a current eDMR submitter please provide your User Id:
User Id
Subscribed and sworn to before me this mi day of Q 20
Signature of Notary Publ c
Printed Name of Notary Public
My Commission Expires:
c
(SEAL)
NCDWR Electronic Submittal Agreement Version 1 Page 4

E. Submitter Signature
The Submitter (electronic signature applicant) is a user other than the Responsible Official who submits
this agreement to request to sign reports electronically. The Submitter is given signatory authority by an
individual identified as the Responsible Official by the Owner/Organization to sign reports and other
information and to accept electronic documents.
I, JeffPhillips (printed name) am authorized b the Res 'bl
Official name in this document,
this agreement for — CommS
y ponsi e
does have the authority under the applicable standards, to enter into
(Owner/Organization Name)
By submitting this application, I, JeffPhilli s (printed name), have
read, understand, and accept the terms and conditions of this Electronic Signature Agreement. I certify
under penalty of law that I have personally examined and am familiar with the information submitted in
this application and all attachments and that, based on my inquiry of those persons immediately
responsible for obtaining the information contained in the application, I believe that the information is
true, accurate and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fine and imprisonment.
Am tter Signature Title Date
Jeff.Phillipsna commscope com 828 241-6039
Email Address Phone Number
*email will be the primary method of contact for the electronic submittal process so it is important to have an accurate email
available at all times
If you are a current eDMR submitter please provide your User Id:
User Id
Subscribed and sworn to before me this o27 day of 71- (�v 20�
Signature of Notary Public
Printed Name of Notary Public
My Commission Expires: (, 3
(SEAL)
NCDWR Electronic Submittal Agreement Version 1 Page 5

E. Submitter Signature
The Submitter (electronic signature
this agreement to request to sign reI
individual identified as the Respons
licant) is a user other than the Responsible Official who submits
electronically. The Submitter is given signatory authority by an
Official by the Owner/Organization to sign reports and other
information and to accept electronic; documents
I, Laura Moody (printed name), am authorized by the Responsible
Official name in this document, who does have the authority under the applicable standards, to enter into
this agreement for CommScone- Catawba (Owner/Organization Name).
By submitting this application, I, Laura Mood
v (printed name), have
read, understand, and accept the terms and conditions of this Electronic Signature Agreement. I certify
under penalty of law that I have personally examined and am familiar with the information submitted in
this application and all attachments and that, based on my inquiry of those persons immediately
responsible for obtaining the information contained in the application, I believe that the information is
true, accurate and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fine and imprisonment.
Submitter Signature Title Date
Laura.Moo yAcommscope com [phone]
Email Address Phone Number
*email will be the primary method of contact for the electronic submittal process so it is important to have an accurate email
available at all times
If you are a current eDMR submitter please provide your User Id:
User Id
Subscribed and sworn to before me this Z�— day of Ive. 2019.
Signa ure of Notary Publi
%,-%ark & -ler
Printed Name of Notary Public
My Commission Expires: 6--- — 3 ae 02 Z
NCDWR Electronic Submittal Agreement Version 1
Page 6

The Submitter (electronic signature'I licant) is a user other than the Responsible Official who submits
this agreement to request to sign reports electronically. The Submitter is given signatory authority by an
individual identified as the Responsible Official by the Owner/Organization to sign reports and other
information and to accept electronics documents.
I, Mark Carpenter (printed name), am authorized by the Responsible Official
name in this document, who does hove the authority under the applicable standards, to enter into this
agreement for CommScope- Catawba (Owner/Organization Name).
By submitting this application, I, Mark Carpenter (printed name), have
read, understand, and accept the terms and conditions of this Electronic ,Signature Agreement. I certify
under penalty of law that I have personally examined and am familiar with the information submitted in
this application and all attachments and that, based on my inquiry of those persons immediately
responsible for obtaining the information contained in the application, I believe that the information is
true, accurate and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fine and imprisonment.
ta__
Submitter Signature Title Date
Mark.D.Carpenter(a)commscope com(828) 241-6249
Email Address Phone Number
*email will be the primary method of contact for the electronic submittal process so it is important to have an accurate email
available at all times
If you are a current eDMR submitter please provide your User Id:
User Id
Subscribed and sworn to before me this ag4A day of RAY 20 If
(SEAL) EIASA M
NOTARY PUBILIC
CATAWBA COUNTY, NC
MY COMMISSION EXPIRES MAY 28, 2023
e& .4 f[UT17XyL-
Signature of Notary Public
u
Printed Name of Notary Public
My Commission Expires: ay
NCDWR Electronic Submittal Agreement Version 1 Page 7

E. Submitter Signature
The Submitter (electronic signature
this agreement to request to sign rel
individual identified as the Respons
information and to accept electronic
applicant) is a user other than the Responsible Official who submits
)rts electronically. The Submitter is given signatory authority by an
ble Official by the Owner/Organization to sign reports and other
documents.
I, Nicole Johnston I (printed name), am authorized by the Responsible Official name in
this document, who does have the authority under the applicable standards, to enter into this agreement
for CommScope- Catawba (Owner/Organization Name).
By submitting this application, I, Nicole Johnston (printed name), have read, understand, and
accept the terms and conditions of this Electronic Signature Agreement. I certify under penalty of law that
I have personally examined and am familiar with the information submitted in this application and all
attachments and that, based on my inquiry of those persons immediately responsible for obtaining the
information contained in the application, I believe that the information is true, accurate and complete. I
am aware that there are significant penalties for submitting false information, including the possibility of
fine and imprisonment.
��� C��`f�� Ervi✓dn�th�a-l� (.ons'c.�i��atf' �/3U/��
Submitter Signature Title Date
Nico1ej!2hnston@yvsa ore Q36) 835-9819
Email Address Phone Number
*email will be the primary method of contact for the electronic submittal process so it is important to have an accurate email
available at all times
If you are a current eDMR submitter please provide your User Id: ilie<�l,johnst;<m 14i?.giuitilwccn.
User Id
Subscribed and swornto before me this -3 0 day of ? " A / 20/'.
Signature of Notary Pu lie
Printed Name of Notary Public
My Commission Expires: — 3 P,�2®.7
(SEAL)
NCDWR Electronic Submittal Agreement Version 1 Page 8