NCG080778_Renewal COC Request_20191025 12:36:16 PM

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NORTH CAFOLINA
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Permit COC
NCG080778
Number *
Enter the Certificate of Coverage (GOC) 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* 3143023634
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.
NCG080778
Permittee
Republic Services of North Carolina LLC
Facility Name
Republic Services of NC, LLC-GDS-
Cleveland
Address
1160 Airport Rd
City
Shelby
County
Cleveland
Waterbody
Hickory Creek
Classification
C
River Basin
Broad
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 *

Date * 10/25/2019