WQ0003396_Operational Agreement_20190626

WATER POLLUTION CONTROL SYSTEM OPERATOR DESIGNATION F?R pt(oWtEC5oOnme�talQuality
NCAC 15A 8G .0201
Press TAB to enter information JUL - 1 2019
Permittee Owner/Officer Name: Jeff McMillian
Email Address: jell},.mcpmiillia([e-mail] Raleigh Regional Office
Permittee Signature: �-0/ // '/ Date:
Facility Name: Arauco North America, Inc. Permit It WQ0003396
SUBMIT A SEPARATE FORM FOR EACH CLASSIFICATION OF SYSTEM: Facility Type: SI 0
Facility Grade: Select
ORC-OPERATOR IN RESPONSIBLE CHARGE
Print Full Name: Yvonne Couts Work Phone: [phone]
Certificate Type: SI Q Certificate Grade: Select Certificate#: 1007988
Email Address: [e-mail]
Signature: Effective Date:
"i certify that i agree my designation as the Operator in Responsible Charge for the facility noted. I understand and will abide by the
rules and regulation ertaining to the responsibilities of the ORC asset forth in 1SA NCAC 08G.0204 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
BACKUP ORC
Print Full Name: Amanda Grenier Work Phone: [phone]
Certificate Type: SI 0 Certificate Grade: Select Certificate#: 1000089
Email Address: am [e-mail]
Signature: Effective Date: 02
"I certify that/agree to my designation as a Back-up 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 foiling to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
Mail,fax or email WPCSOCC,1618 Mail Service Center,Raleigh,NC 27699-1618
ORIGINAL to: Email:[e-mail] Fax:[phone]
Mail or Fax a COPY to: Asheville Fayetteville Mooresville Raleigh
2090 US Hwy70 225 Green St.,Suite 714 610 E.Center Ave.,Suite 301 3800 Barrett Dr.
Swannanoa, NC 28778 Fayetteville, NC 28301-5043 Mooresville, NC 28115 Raleigh, NC 27609
Fax:[phone] Fax:[phone] Fax:[phone] Fax:[phone]
Phone:[phone] Phone:[phone] Phone:[phone] Phone:[phone]
Washington Wilmington Winston-Salem
943 Washington Sq.Mall 127 Cardinal Dr. 45 W.Hanes Mill Rd.
Washington,NC 27889 Wilmington, NC 28405-284S Winston-Salem,NC 2710S
Fax:[phone] Fax:[phone] Fax:[phone] Phone:
Phone:[phone] Phone:[phone] 336-776-9800 Revised52019