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HomeMy WebLinkAboutNCG080819_Renewal COC Request_20181210 1:10:07 PM'rl n NORTH CAFOLINA Emlre -.1 Qd Wy Permit COC NCG080819 Number * Enter the Certificate of Coverage (COC) number, not the General Fbrmt number (e.g., NCGO30222 is the COC, not NCG030000) M-ST BEGIN WTTH CAPITAL "NCG' Name of Person Zak Lokken Obtaining COC* First and LastNarre Phone Number* 9197552446 Email * lokken.zak@rnc.sysco.com The COC will be e-rrailed to this contact. Additional Email lokken.zak@rnc.sysco.com (Optional) Enter an additional email address to whom to send the COC Please review the information below for accuracy before submitting. If there are inconsistencies, please contact Bethany Georgoulias at (919) 707-3641 or bethany.georgoulias@ncdenr.gov. M aste r Ge ne ral NCG080000 Permit No. COC No. NCG080819 Permittee Sysco Food Services of Raleigh Facility Name Sysco Food Services of Raleigh Address 1032 Baugh Rd City Selma County Johnston Waterbody Mill Creek (at Selma) Classification WS-IV;NSW River Basin Neuse RENEWAL STATUS Active Issuance Date * 10/29/2018 Effective Date 11/01/2018 I hereby request a copy of the Certificate of Coverage (COC) entered above. I understand that the COC e-mailed as a result of this request will serve as the Permittee's record of renewed coverage under the General Permit, and that this record must be maintained with the Permittee's NPDES Stormwater Permit records. Signature �+ Date * 12/10/2018