Request for Listing as a North Carolina



Request for Listing as a North Carolina

Water Pollution Control System Contract Operator

Effective December 1, 2006, North Carolina regulations no longer require water pollution control system contract operators or contract operations firms to submit annual reports.

Submission of this form is considered a request to list your or your company’s name and information on a list of contract operators that is available to the public. To remain on the list, you must submit this form at least every twelve months.

|Contract Operator or Operation Firm Name |

|Owner’s Name |Contact Person |

|Street Address or PO Box |

|City |State |Zip |

|Phone # |Phone # |

| | |

|Fax # |Email / Website |

I am interested in offering my/my company’s services for the types of systems checked below:

|Biological Wastewater (WW) | | |Surface Irrigation (SI) | |

|Collections (CS) | | |Subsurface (SS) | |

|Physical/Chemical (PC) | | |Type A Animal Waste (AWA) | |

|Land Application (LA) | | |Type B Animal Waste (AWB) | |

I am interested in offering my/my company’s services in the counties listed below:

| |

| |

| |

Signature of Owner Date

Submit to:

WPCSOCC Phone: (919) 707-9105

Division of Water Resources Fax: (919) 715-2729

1618 Mail Service Center Email: Beth.Buffington@ Raleigh NC 27699 -1618

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