NCG200353_Renewal COC Request_20191113 9:56:00 AM

NORTH C W Q-rA
EnHmnmertm! dafny
Permit COC
NCG200353
Number *
Enter the Certificate of Coverage (COC) nun ber, not the General Pen-rit 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.
NCG200353
Permittee
Omnisource LLC
Facility Name
OmniSource Southeast, LLC - Kernersville
Address
1426 W Mtn St
City
Kernersville
County
Forsyth
Waterbody
Kerners Mill Creek
Classification
WS-III
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