NCG180231_Renewal COC Request_20191120 2:12:19 PM

NORTH C W Q-rA
EnHmnmertm! dafny
Permit COC
Number*
Name of Person
Obtaining COC*
Phone Number*
NCG 180231
Enter the Certificate of Coverage (COC) nun ber, not the General Pen-rit nurrber (e.g., NOG030222 is the COC, not
N00030000) M-ST BEGIN WTTH CARTAL "NCG'
George Donnell
First and Last Nacre
336-215-5043
Email* [e-mail]
The COC w ill be e-nailed to this contact.
Additional Email [e-mail]
(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].
Master General NCG180000
Permit No.
COC No.
NCG180231
Permittee
Rockwell Collins Inc
Facility Name
Rockwell Collins Inc.
Address
1455 Fairchild Rd
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 /20/2019