NCG140050_Renewal COC Request Review_20220913

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 9/13/2022 10:30:20 AM (COC Request Submission)
Submit by Tran, Kieu M 9/13/2022 11:24:50 AM (Review COC Request for NCG140050)
• Georgoulias, Bethany A reassigned the task to Tran, Kieu M 9/13/2022 10:33 AM
* Paid up (check processed 8/18/2022) - needs to be renewed in BIMS and then you can generate
the COC with this request.
• The task was assigned to Georgoulias, Bethany A. The due date is: September 16, 2022 5:00 PM
9/13/2022 10:30 AM

Permit COC Number* NCG140050
Enter the Certificate of Coverage (COC) number. MUST BEGIN WITH CAPITAL "NCG"
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.
the COC is still expired, but owed fees have been paid.
permit information is incorrect or old.
Master General Permit NCG140000
Issuance Date* 06/30/2022
Master General Permit Issuance
Effective Date 07/01/2022
Master General Permit Effective
Name of Person Bethany Georgoulias (on behalf of Johnie Alexander, per email 9/12/2022)
Requesting COC* First and Last Name
Phone Number* [phone]
Email* [e-mail]
The COC will be e-mailed to this contact.
Additional Email [e-mail]
(Optional) Enter an additional email address to whom to send the COC
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 * 09/13/2022
Time 10:30:20 AM
Permittee * Verify owner/operator is correct.
Concrete Supply Co LLC
Facility Name* Concrete Supply Co -Shelby
Verify facility name is correct.
Address 303 S Morgan St
City Shelby

County Cleveland
Is the COC eligible Check to see if it has already been renewed/created before choosing "Yes"
for renewal or . Yes (will generate a new COC).
revision?* No, fees are still outstanding.
No, it was already renewed and is available.
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 BIMS.
Buffalo Creek
Waterbody
(e.g., WS-IV) List multiple classifications as they should read on the COC.
Classification(s)*
C
River Basin(s) *
Enter the name of the river basin(s) the receiving waters drain in.
Broad
(Just the Basin name. Do not include the words 'River Basin")
COC Issuance Date*
9/13/2022
COC Effective Date*
9/13/2022
WW Heading* AND WASTEWATER
This field will be hidden but used on the COC.
WW Discharge* and wastewater
This field will be hidden but used on the COC.
COC status in BIMS Choose Active if you have just renewed the COC successfully.
Now* • Active
Expired
Inactive
Comments Additional information to convey to requester in e-mail communication.
Outstanding fee check was processed on 8/18/2022
Document(s) to add Documents that may be helpful to send requester (e.g., fees owed letter or BIMS screen shot).
to records PDF or JPG allowed
Request Instance ID 105335
For request tracking purposes only.
Review Date* 9/13/2022