NCG080805_Renewal COC Request_20191025 11:16:49 AM

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NORTH CAFOLINA
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Permit COC
NCG080805
Number *
Enter the Certificate of Coverage (OOC) number, not the General Fbrmt nurrber (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAFTTAL "NCG'
Name of Person
Derek Bouchard
Obtaining COC*
First and LastNarra
Phone Number* 314-302-3634
Email * [e-mail]
The COC will be e-rrailed to this contact.
Additional Email (Optional) Enter an additional email address to whom to send the CDC
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 NCG080000
Permit No.
COC No.
NCG080805
Permittee
Republic Services of North Carolina LLC
Facility Name
RWS-Greensboro
Address
2140 Bishop Rd
City
Greensboro
County
Guilford
Waterbody
Hickory Creek
Classification
WS-IV:*
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 *
cat AVID &I
Date * 10/25/2019