NCG030666_Renewal COC Request_20191203 8:43:04 AM

NORTH C W Q-rA
EnHmnmertm! dafny
Permit COC
NCG030666
Number *
Enter the Certificate of Coverage (COC) nun ber, not the General Rarnit nurrber (e.g., N00030222 is the OOC, not
NCG030000) M-ST BEGIN WTTH CARTAL "NCG'
Name of Person
Bethany Georgoulias
Obtaining COC*
First and Last Name
Phone Number*
[phone]
Email*
[e-mail]
The COC w ill be e-nailed to this contact.
Additional Email
(Optional) Enter an additional email address towhom tosend the OOC
Please review the information below for accuracy before submitting. If there are inconsistencies, please
contact Bethany Georgoulias at [phone] or [e-mail].
M aste r Ge ne ral
NCG030000
Permit No.
COC No.
NCG030666
Permittee
John Peters
Facility Name
US Chemical Storage (Wilkesboro)
Address
1806 River St
City
Wilkesboro
County
Wilkes
Waterbody
YADKIN RIVER
Classification
WS-IV
River Basin
Yadkin
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 * 12/03/2019