NC0023604_Signature Authority_20190709

July 9,2019
Wastewater Branch �ECEIr
Water Quality Permitting Section /ED/NODE6)/DWW
Division of Water Resources
1617 Mail Service Center AUG 2 642001 1g
Raleigh, NC 27699-1617
Water Qfty
Permifting flgtt
Subject: Delegation of Signature Authority
ENTER FACILITY NAME W l L i�E f`r 3E SS ^1C i�C
NPDES Permit Number NC NV ooa 36,o 4/
To Whom It May Concern:
By notice of this letter. 1 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 #2 (if applicable)
Name: , Q. Lan David "Tiara Lie
Title: 512_cg-er 4-arq ERG
Mailing Address: 'RO ii3c�x Z. 3Cn -Pc.) 3ox Zt 3 Co
Le-61rz9-Voyn, ►—sC 077 43 Lex�r�c -}on , 9 3
Physical Address: 313 Neu Cs-L-A- Road 3t3 l�eti,,) CLA..+ Kci
(if different) Lexerlg{-on 1 /JC o1^17l9z Le , c .9Z
Email Address: bejtndac�. w►1dert‘e9slumber.cow, sa --L{ cot.[clef rv95 tur►'Lbef.Co("-
Office Phone: 33(0 -47'- 23 ty 334, - Z31 I
Mobile Phone: - - -3((3
If you have any questions regarding this letter, please feel free to contact me at Enter Email or Phone
N umber.
Sincerely,
Authorized Signing Official's Name
Authorized Signing Official's Title
Mailing Address'Po cK Zl3[a
Email Address P.siti ..L c Qr,\e55 Lumber.cosy,
Office Phone 33G-q-`F{-2.31c
Mobile Phone 5q o -37,0- 65-q'y
cc: • . • Regional Office, Water Quality Permitting Section

D. Responsible Official Signature
The Responsible Official,as identified in accordance with-10('I•R 1 22.22, is the appropriate individual
with the authority to sign and submit reports for the organization.
1, —RolrAte 1) 'o tk (printed name), have the authority to enter into this
Agreement for lam)t,icier fRQ55 lUC r I t1C, (Owner/OrganizationName).
I request the NCDWR grant me and, if included in Sections C and C' 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.
13y submitting this application. I. Ro\rw,_ i).Jo\T (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.
P7-3,, • c.......9 /la %If—-,‘-.5 9-- /ai • / ,
Responsible Official Signature '"Title Date
Irak)@ w ticubrrr.Q.ss lure. be('cow 334-4?4-- zly
Email Address Phone Number
*email will he the primary method oi'contact IN.the electronic submittal process so it is important to have an accurate email ' 1''
available at all times
If you are a current eDMR submitter please provide your User Id: t(dNt, 1.,0 Ad2C ReSs lu.n .loex ,COc\.
User Id
Subscribed and sworn to before me this 12 , day of '3'i\y , 20 % .
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12/31/2023 Printed Name o of-Notary Pub We
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My Commission Expires: IZ/31/2023
(SEAL)
NCDWR Electronic Submittal Agreement Version 1 Page 4