NCG120051_Renewal COC Request Review_20210826

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 8/25/2021 10:16:07 AM (COC Request Submission)
Submit by McCoy, Suzanne 8/26/2021 10:11:35 AM (Review COC Request for NCG120051)
• The task was assigned to McCoy, Suzanne. The due date is: August 30, 2021 5:00 PM
8/25/2021 10:16 AM

Permit COC NCG120051
Number * Enter the Certificate of Coverage (OOC) 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 Mike Gurley
Requesting COC* First and Last Nbme
Phone Number* 7044006557
Email * [e-mail]
The OOC w ill be e-nailed to this contact.
Additional Email [e-mail]
(Optional) Enter an additional email address to whom to send the ODC
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
Date * 08/25/2021
Time 10:16:07 AM
Permittee * Verify owner/operator is correct.
Republic Services of North Carolina LLC - Richmond
Facility Name * Republic Services of NC LLC - Mt. Gilead 2
Verify facility nacre is correct.
Address 500 Landfill Rd
City Mount Gilead

County Montgomery
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.
f 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.
Rocky Creek (Rocky River)
Wate rbody
(e.g., WSIV) List rrultiple classifications as they should read on the �C
Classification(s) *
C; SW
River Basin(s) *
Enter the river basin(s) the receiving waters drain in.
Yadkin
COC Issuance Date*
8/26/2021
COC Effective Date*
8/26/2021
COC status in BIMS Choose Active if you have just renewed the ODCsuccessfully.
Now* r Active
f Expired
f Inactive
Comments Additional inforrration to convey to requester in a-rrail corrrrunication.
Attached is a renewal COC.
Document(s) to add Docurrents that rray be helpful to send requester (e.g., fees owed letter or BINS screen shot).
to records FDForJFGallowed
Request Instance ID 62925
For request tracking purposes only.
Review Date * 8/26/2021