NC0085928_Other Agency Documents_20190905

09-05-'19 07:17 FROM -Excel Env 704-853-3949 T-158 P0001/0001 F-210
WATER POLLUTION CONTROL SYSTEM OPERATOR DESIGNATION FORM (WPCSOCC)
NCAC 1SA 8G .0201
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Permittee Owner/Officer Name: American 7lvetzschler, Inc. / John Guglielmatti
Email Address:Jgugliclmetti(clam-truetzschler.com
PennitteeSignature: _Vt UA - ;a'4614- Date:
Facility Name: American Truetzschier, Inc.
Permit# NCO085928
SUBMIT SEPARATE FORM FOR EACH CLASSIFICATION OF SYSTEM: Facility Type: PC
Facility Grade' I
.ORE -OPERATOR IN RESPONSIBLE CHARGE
Print Full Name: Kellie Hedrick Work Phone: [phone]
Certificate Type: PC
Email Address:
Certificate Grade: II Certificate#: 28628
Signature: Effective Date: K(a-1 I L01
"I certify that I agree to my dell nation a i - Operator in Responsible Charge for the facility noted- I understand and will abide by the
rules and regulations pertaining to the respadsibilitles of the ORC as set forth In 15A NCAC 02G.0204 and falling to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certification Commission."
BACKUP ORC
Print Full Name: [lyyrt-icegV CS Work Phone: 'l wI-33'.l -Slur-+a
Certificate Type: Q('.. Certificate Grade: Certificate it: 986382,
Email Address: rrie �n<.Y..r,-,4�-nc, wm ^
Signature:
Effective Date: 9 -3 _ 19
"I certify that I agree to my deYgnatlon 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 15A NCAC 080.0204 and failing to do so can result in
Disciplinary Actions by the Water Pollution Control System Operators Certlfirotion Commission."
Mail, fax or emall WPCSOCC, 1.618 Mail Service Center, Raleigh, NC 27699-1618
ORIGINAL to: Small: certadmhi®ncdenr.gov Fax: [phone]
Mail or Fax a COPY to: Asheville Fayetteville
2090 US Hwy 70 225 Green St., Suite 714
Swannanoa, NC 28778 Fayetteville, NC 28301-5043
Fax: [phone] Fax:[phone]
Phone: [phone] Phone: 91OA33-3300
Washington
943 Washington Sq. Mall
Washington, NC 27889
Fax: [phone]
Phone: [phone]
Wilmington
127 Cardinal Dr.
Wilmington, NC 28405-2845
Fax: [phone]
Phone: [phone]S
Mooresville -
610 E. Center Ave., Suite 301
Mooresville, NC 28115
Fax: [phone]
Phone: [phone]
Winston-Salem
45 W. Hanes Mill Rd.
Winston-Salem, NC 27105
Fax: [phone] Phone:
336-77"800
Raleigh
380o Barrett Dr.
Raleigh, NC 27809
Fax: [phone]
Phone: [phone]
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