NCG200349_Renewal COC Request_20191113 9:48:45 AM

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Permit COC
NCG200349
Number *
Enter the Certificate of Coverage (COC) nun ber, not the General Pernit nurrber (e.g., N00030222 is the ODC, not
NCG030000) M-ST BEGIN WTTH CARTAL "NCG'
Name of Person
James Winegar
Obtaining COC*
First and Last Narre
Phone Number*
9199893102
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
NCG200000
Permit No.
COC No.
NCG200349
Permittee
Omnisource LLC
Facility Name
OmniSource, LLC (Winston-Salem)
Address
3415 N Glenn Ave
City
Winston Salem
County
Forsyth
Waterbody
Brushy Fork
Classification
C
River Basin
Yadkin
RENEWAL STATUS
Active
Issuance Date*
08/01/2019
Effective Date
08/01/2019
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 * 11 /13/2019