2017-359 Planning - City of Mebane amendment to Efland Sewer Maintenance Contract

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EXHIBIT A WPCSOCC Operator Designation Form(continued) Page 2 Facility Name: Efland Cheek Collection System Permit M WOS00194 BACKUP ORC Print Full Name: Gregory Robert Barts Work Phone:919-563-3401 Certificate Type: CS Certificate Grade: III Certificate M 995847 Email Address: gbarts@cityofmebane.com Signature: Effective Date: "I certify that I agree tom 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 15A 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: Jeffrey A. Jobe Work Phone:919-563-3401 Certificate Type: CS Certificate Grade: III Certificate#:1001403 Email Address: Mobe @cityofinebane.com Signature: Effective Date: '-{-as- 19.0 1 7 "I certify that I agree to d iron Back rotor 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 O8G.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: Work Phone: Certificate Type: Select Certificate Grade: Select Certificate M Email Address: Signature: Effective Date: "I 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 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 Disciplinary Actions by the Water Pollution Control System Operators Certification Commission." BACKUP ORC Print Full Name: Work Phone: Certificate Type: Select Certificate Grade: Select Certificate M Email Address: Signature: Effective Date: Of 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 the rules and regulations pertaining to the responsibilities of the ORC as set forth in 15A NCAC 09G.0204 and failing to do so can result in Disciplinary Actions by the Water Pollution Control System Operators Certification Commission." Revised 412016