NCG060208_Renewal COC Request_20201203 2:29:42 PM

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/3/2020 2:29:42 PM (COC Request Submission)

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Permit COC
NCG060208
Number *
Enter the Certificate of Coverage (COC) nun ber, not the General Pernit nurrber (e.g., N00030222 is the OOC, not
NCG030000) M-ST BEGIN WTTH CARTAL "NCG'
Name of Person
Gabriel Araos
Obtaining COC*
First and Last Name
Phone Number* 919-871-0999
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.
NCG060208
Permittee
Pepsi Bottling Ventures LLC
Facility Name
Pepsi Bottling Ventures -Winston
Address
3425 Myer Lee Dr
City
Winston Salem
County
Forsyth
Waterbody
Salem Creek (Middle Fork Muddy Creek,
Salem Lake)
Classification
WS-III;CA
River Basin
Yadkin
RENEWAL STATUS
Active
Issuance Date*
10/29/2018
Effective Date
11/01/2018
Effective Date
20181101
Reformatted
I 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 *
Date * 12/03/2020