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EXHIBIT A <br /> WATER POLLUTION CONTROL SYSTEM OPERATOR DESIGNATION FORM (WPCSOCC) <br /> NCAC 15A 8G .0201 <br /> Press TAB to enter information 1 <br /> Permittee Owner/Officer Name: Orange CountylZon�1%G ljammeolsleX, Court 6) J%-n qgC/' <br /> Mailing address: 131 W Margaret Lane, PO Box 8181 Phone: 919-245-2583 <br /> City: Hillsborough State: NC Zip: 27278 <br /> Email Address: areinert@orangecountync.gov p <br /> Signature: Date: 0 <br /> Facility Name: Efland Cheek Collection System permit# WQCS00194 <br /> County: Orange <br /> YOU MUST SUBMIT A SEPARATE FORM FOR EACH TYPE AND CLASSIFICATION OF SYSTEM: <br /> Facility Type: CS <br /> Facility Grade: III <br /> OPERATOR IN RESPONSIBLE CHARGE(ORC) <br /> Print Full Name: Charlie W. Pore Work Phone: 919-563-3401 <br /> Certificate Type: CS Certificate Grade: IV Certificate#: 994130 <br /> Email Address: wpore @cityofinebane.com <br /> Signature: C ),��,�(a t _PU,� Effective Date: -A 9'- X p 1 <br /> "I certify that 1 agree to my designation as the Operator in Responsible Charge for the facility noted. I understand and will abide by the <br /> rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G.0204 and failing to do so can result in <br /> Disciplinary Actions by the Water Pollution Control System Operators Certification Commission." <br /> a BACKUP ORC <br /> Print Full Name: Ronnie D. Maness Work Phone:919-563-3401 <br /> Certificate Type: CS Certificate Grade: III Certificate#:994454 <br /> Email Address: rmaness @cityofinebane.com <br /> Signature: 1) 1 Effective Date: -oZ- <br /> "1 certify that i agree to my designation as a Back-up Operator in Responsible Charge for the facility noted. I understand and will abide by <br /> the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 08G.0204 and failing to do so can result in <br /> Disciplinary Actions by the Water Pollution Control System Operators Certification Commission." <br /> Mail,fax or email WPCSOCC, 1618 Mail Service Center, Fax:919-715-2726 16rr>il:certadmk*ncdenr gov <br /> ORIGINAL to: Raleigh,NC 27699-1618 <br /> Mail or Fax Asheville Fayetteville Mooresville Raleigh <br /> a COPY to: 2090 US Hwy 70 225 Green St.,Suite 714 610 E.Center Ave.,Suite 301 3800 Barrett Dr. <br /> Swannanoa,NC 28778 Fayetteville,NC 28301-5043 Mooresville,NC 28115 Raleigh,NC 27609 <br /> Fax:828-299-7043 Fax:910-496-0707 Fax:704-663-6040 Fax:919-571-4718 <br /> Phone:828-296-4500 Phone:910-433-3300 Phone:704-663-1699 Phone:919-791-4200 <br /> Washington Wilmington Winston-Salem <br /> 943 Washington Sq.Mall 127 Cardinal Dr. 45 W.Hanes Mall Rd. <br /> Washington,NC 27889 Wilmington,NC 28405-2845 Winston-Salem,NC 27105 <br /> Fax:252-946-9215 For.910-350-2004 Fax:336-776-9797 <br /> Phone:252-946-6481 Phone:910-796-7215 Phone:336-776-98M RevMdaQws <br />