NCG120107_Renewal COC Request_20181128 8:53:24 AM

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NORTH CAFOLINA
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Permit COC
NCG120107
Number *
Enter the Certificate of Coverage (COC) number, not the General Fbrmt number (e.g., NCGO30222 is the COC, not
NOG030000) M-ST BEGIN WTTH CAPITAL "NCG'
Name of Person
Daniel Moore
Obtaining COC*
First and LastNarre
Phone Number* 3362530091
Email * [e-mail]
The COC will be e-rrailed to this contact.
Additional Email [e-mail]
(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 [phone] or [e-mail].
Master General NCG120000
Permit No.
COC No.
NCG120107
Permittee
Waste Management of Carolinas Inc
Facility Name
Great Oak Landfill
Address
3597 Old Cedar Falls Rd
City
Randleman
County
Randolph
Waterbody
Gabriels Creek
Classification
C
River Basin
Cape Fear
RENEWAL STATUS
Active
Issuance Date *
10/29/2018
Effective Date
11/01/2018
1 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 *
PA-�14-L 1"00

Date * 11 /28/2018