NCG060100_Renewal COC DEQ-Initiated Record_20201001

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Georgoulias, Bethany 10/1/2020 11:14:41 AM (COC Request Submission)

NORTH C W Q-rA
EnHmnmertm! dafny
Permit COC
NCG060100
Number *
Enter the Certificate of Coverage (COC) nun ber, not the General Parnit nurrber (e.g., N00030222 is the OOC, not
NCG030000) M-ST BEGIN WTTH CARTAL "NCG'
Name of Person
Bethany Georgoulias
Obtaining COC*
First and Last Name
Phone Number* [phone]
Email* [e-mail]
The COC w ill be e-nailed to this contact.
Additional Email (Optional) Enter an additional enailaddress towhom tosend the OOC
Did you check the permit COC file in our repository to ensure this COC was not already available from a previous
request? If it is, please obtain it from there instead of this form.
rJ Yes, this COC was not already there.
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.
NCG060100
Permittee
Kansas City Sausage Company LLC
Facility Name
Coastal Protein WWTF
Address
1600 Martin Rd
City
Godwin
County
Sampson
Waterbody
South River
Classification
C;Sw
River Basin
Cape Fear
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.
In addition, I agree that submission of this form is a "transaction" subject to Chapter 66, Article 40 of the NC General

Statutes (the "Uniform Electronic Transactions Act'); and I agree to conduct this transaction by electronic means
pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act');
Signature *
�r1sr� ��1�9.�ctrclec�J
Date * 10/01 /2020