NCC210941_Modification Review_20210701

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 7/1/2021 11:55:11 AM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany A 7/1/2021 3:17:05 PM (Construction COC ADD TO FILE Review- NCC210941)
The task was assigned to Georgoulias, Bethany A. The due date is: July 6, 2021 5:00 PM
7/1/2021 11:55 AM

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NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of NCC210941
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
Information associated with this permit
Project Name
PNG Line 466 Pipeline
Address
Highway 11, Grainger Station Rd., and Faulkner Rd., Kinston, NC
County
Lenoir
Latitude
35.3161
Longitude
-77.4936
Permittee Listed
Piedmont Natural Gas Company, Inc.
Legally Responsible
Dave Vena
Individual
NC Reference No.
NCG01-2021-0941
E&SC Plan ID
LENOI-2021-012
Original NOI
44542
Tracking No.*
Date COC Issued*
02/17/2021
Prior Rescission
This field will populate only if CCChas already been rescinded.
Date
Modification Information:
Reason for r Closed -Out Lots/Outparcels in E&SC Plan
Modification * r Additional Lots/Outparcels Approved - E&SC Revised
F Other Revision(s) to E&SC Plan
r Legally Responsible Individual and/or Site Contact Has Changed
r Multiple Reasons (List)
Addional Ivbre information (e.g., new Site Contact details). If lots are being added, please include specific lot numbers.
Explanation Additional LOD
You must upload supporting documentation below. Do not upload E&SC Plans unless specific plan
sheets are the only documentation with approval for revised acres of disturbance, etc. (only upload applicable
sheets).
For changes to the legally responsible individual, you must upload this form.

Supporting Upload Supporting Documentation (%vised IRSCApproval, (lose -Out Doc, etc.)
Documentation Lenoi-2021-012 PNG Line 466 Pipeline - 07012021
831.7KB
(REV).pdf
Wst be FDFformat
North Carolina General Statute 143-215.6113 (i) provides that:
Anyperson who knowinglymakes anyfalse statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained under this Article or a rule implementing this Article; or who knowinglymakes a false statement
of a material fact in a rulemaking proceeding or contested case underthis Article; orwho falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine notto exceed ten thousand
dollars ($10,000).
� I hereby request modification to coverage under the NPDES Stormwater Permit
for the subject project site. I am familiar with the information contained in this
request and to the best of my knowledge and belief such information is true,
complete and accurate.
Specify if you are:* r The Legally Responsible Individual
f Authorized Responsible Person*
*This form must be signed by a responsible corporate officer that owns or operates the construction activity, such as a
president, secretary, treasurer, or vice president, or a manager that is authorized in accordance with Part IV, Section B,
Item (6) of the NCG010000 General Permit. For more information on signatory requirements, see Part IV, Section B,
Item (6) of that permit.
Signature
Type Name* Dave Vena
Title * Project Manager
Organization* Piedmont Natural Gas Company, Inc.
Date * 07/01 /2021
Email Address* [e-mail]
En -ail for confirmation
Telephone Number* 704-731-4496
Contact number if we need to reach you
Note: Original permittee and site contact are copied on modification correspondence.
Additional Email [e-mail]
(Optional) Additional email for confirmation
Original Permittee [e-mail]
Email
Original Site Contact [e-mail]
Email
Review Date 07/01/2021
Rescinded Since
Submitted?

Request Date 20210701
Formatted
Review Date 20210701
Formatted