HomeMy WebLinkAboutNCG060007_Renewal COC Request_20210602 1:52:28 PMAction History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 6/2/2021 1:52:26 PM (COC Request Submission)
NORTH C W Q-rA
EnHmnmertm! dafny
Permit COC
NCG060007
Number *
Enter the Certificate of Coverage (COC) nun ber, not the General P n-rit nurrber (e.g., N00030222 is the OOC, not
NCG030000) M-ST BEGIN WTTH CARTAL "NCG'
Name of Person
Tina Williams
Obtaining COC*
First and Last Narre
Phone Number*
3363616027
Email * tina.Wlliams@doradafoods.com
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 (919) 707-3641 or bethany.georgoulias@ncdenr.gov.
M aste r Ge ne ral NCG060000
Permit No.
COC No.
NCG060007
Permittee
Keystone Foods
Facility Name
Keystone Foods
Address
227 Equity Dr May 87
City
Reidsville
County
Rockingham
Waterbody
Little Troublesome Creek
Classification
WS-V;NSW
River Basin
Cape Fear
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 *
O 4tca1xd
Date * 06/02/2021