NCG120068_Renewal COC Request Review_20210817

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/6/2021 8:04:06 AM (COC Request Submission)
Submit by McCoy, Suzanne 8/17/2021 2:00:00 PM (Review COC Request for NCG120068)
• Georgoulias, Bethany A reassigned the task to McCoy, Suzanne 8/6/2021 9:52 AM
p Suzanne, I think this is finally a real random renewal. Sending it your way.
The task was assigned to Georgoulias, Bethany A. The due date is: August 11, 2021 5:00 PM
8/6/2021 8:04 AM

Permit COC NCG120068
Number * Enter the Certificate of Coverage (COC) nun ber. MIST BEGIN WTTH CARTAL "NOG'
NOTE: You can verify the COC facility information and renewal status by running this Permit Summary Report (check the
Permit Status at the top of the report). If the permit is expired, a renewal COC will not be available. This may be
because fees are owed. You can check for outstanding invoices at https://deq.nc.gov/sw-epayments.
V the COC is still expired, but owed fees have been paid.
r permit information is incorrect or old.
Master General Permit NCG 120000
Issuance Date*
06/30/2021
Mister General Perrrit Issuance
Effective Date
07/01/2021
Master General Pernit Efective
Name of Person
Amber Grzymski
Requesting COC*
First and LastNlarre
Phone Number* 9803143855
Email * [e-mail]
The OOC w ill be e-nailed to this contact.
Additional Email (Optional) Enter an additional enailaddress towhom tosend the OOC
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. If a COC is not available, I request a
follow-up from Stormwater Program staff.
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
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Date * 08/06/2021
Time 08:04:06 AM
Permittee * Verify owner/operator is correct.
Mecklenburg County Solid Waste
Facility Name * Mecklenburg Co -Highway 521 Landfill
Verify facility nacre is correct.
Address 17131 Lancaster Hwy
City Charlotte
County Mecklenburg

Is the COC eligible Check to see if it has already been renewed/created before choosing "Yes"
for renewal or r Yes (will generate anew COC).
revision?* r No, fees are still outstanding.
f No, it was already renewed and is available.
r No, for another reason.
If the COC needs to be renewed or corrected, enter waterbody information and appropriate dates below.
Receiving Water(s)
* Enter all unique receiving waters identified in BINS.
Sixmile Creek
Wate rbody
(e.g., WSIV) List rrultiple classifications as they should read on the COG
Classification(s) *
C
River Basin(s) *
Enter the river basin(s) the receiving waters drain in.
Catawba
COC Issuance Date*
8/17/2021
COC Effective Date*
8/17/2021
COC status in BIMS Choose Active if you have just renewed the 00Csuccessfully.
Now* r Active
f Expired
f Inactive
Comments Additional information to convey to requester in a-rrail commnication.
Confirmed fees paid. Permit now Active, thank you for your patience.
Document(s) to add Documents that nay be helpful to send requester (e.g., fees owed letter or BINS screen shot).
to records FDForJFGallowed
Request Instance ID 61508
For request tracking purposes only.
Review Date * 8/17/2021