NCG080630_Renewal COC Request_20200512 10:41:09 AM

NORTH C W Q-rA
EnHmnmertm! dafny
Permit COC
NCG080630
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
Terri Allen
Obtaining COC*
First and Last Name
Phone Number*
404-904-5122
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
NCG080000
Permit No.
COC No.
NCG080630
Permittee
Norfolk Southern Railway Company
Facility Name
Norfolk Southern Railway Co - Gaynor St
Address
600 Gaynor St
City
Winston Salem
County
Forsyth
Waterbody
Brushy Fork
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 *
pw-lee-04leff,
Date * 05/12/2020