NCG200420_Renewal COC Request_20210226 8:23:55 AM

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 2/26/2021 8:23:54 AM (COC Request Submission)

NORTH C W Q-rA
EnHmnmertm! dafny
Permit COC
NCG200420
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
Evelyn L. Walker
Obtaining COC*
First and Last Name
Phone Number* 336-382-3264
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
NCG200000
Permit No.
COC No.
NCG200420
Permittee
DH Griffin Wrecking Company Inc
Facility Name
D H Griffin Wrecking Co Incorporated
Address
4700 Hilltop Rd
City
Greensboro
County
Guilford
Waterbody
Ellerbe Creek
Classification
WS-IV;NSW
River Basin
Neuse
RENEWAL STATUS
Active
Issuance Date*
08/01/2019
Effective Date
08/01/2019
Effective Date
20190801
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 *
651;pt�w le amw
Date * 02/26/2021