NCG120103_Renewal COC Request_20190109 11:27:55 AM

'rl n
NORTH CAFOLINA
Emlre -.1 Qd Wy
Permit COC
NCG120103
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
JUSTIN HARRISON
Obtaining COC*
First and Last Nlarre
Phone Number* 1-252-799-6552
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.
NCG120103
Permittee
Martin County C&D Landfill
Facility Name
Martin County C&D Landfill
Address
1445 Landfill Rd
City
Williamston
County
Martin
Waterbody
Mill Branch
Classification
WS-IV
River Basin
Roanoke
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 *
4*W1 W_te'Y

Date * 01 /09/2019