NCG080711_Renewal COC Request Review_20210927

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/27/2021 11:02:36 AM (COC Request Submission)
Submit by McCoy, Suzanne 9/27/2021 3:56:59 PM (Review COC Request for NCG080711)
• The task was assigned to McCoy, Suzanne. The due date is: September 30, 2021 5:00 PM
9/27/2021 11:02 AM

Permit COC NCG080711
Number * Enter the Certificate of Coverage (OOC) nun ber. MIST BEGIN WTI H 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 NCG080000
Issuance Date* 06/30/2021
Mister General Perrrit Issuance
Effective Date 07/01/2021
Master General Pernit Efective
Name of Person Sam Ingram
Requesting COC* First and LastN�irre
Phone Number* 704-391-4327
Email* [e-mail]
The COC w ill be e-nailed to this contact.
Additional Email [e-mail]
(Optional) Enter an additional enail address to whom to send 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
Date *
09/27/2021
Time
11:02:36 AM
Permittee *
Verify owner/operator is correct.
North Carolina Air Guard
Facility Name *
263rd Combat Communications Squadron
Verify facility narre is correct.
Address
39399 Hercules Dr
City
New London

County Stanly
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.
Little Mountain Creek
Wate rbody
(e.g., VVS-IV) List rrultiple classifications as they should read on the �C
Classification(s) *
WS-IV
River Basin(s) *
Enter the river basin(s) the receiving waters drain in.
Yadkin
COC Issuance Date*
9/27/2021
COC Effective Date*
9/7/2021
COC status in BIMS Choose Active if you have just renewed the CDCsuccessfully.
Now* r Active
f Expired
f Inactive
Comments Additional information to convey to requester in e-mail comrunication.
Document(s) to add Docurrents that may be helpful to send requester (e.g., fees owed letter or BINS screen shot).
to records FDForJFGallowed
Request Instance ID 66547
For request tracking purposes only.
Review Date * 9/27/2021