NCG060306_Renewal COC Request_20200409 8:21:20 AM

NORTH C W Q-rA
EnHmnmertm! dafny
Permit COC
NCG060306
Number *
Enter the Certificate of Coverage (COC) nun ber, not the General Parnit nurrber (e.g., N00030222 is the ODC, not
NCG030000) M-ST BEGIN WTTH CARTAL "NCG'
Name of Person
Bob Hayes
Obtaining COC*
First and Last Name
Phone Number*
7134499062
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
NCG060000
Permit No.
COC No.
NCG060306
Permittee
Land O'Lakes
Facility Name
Land O'Lakes Purina Feeds, LLC
Address
173 McNess Rd
City
Statesville
County
Iredell
Waterbody
Third Creek (Third Creek WS No. 37)
Classification
C
River Basin
Yadkin
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 * 04/09/2020