NCG140003_Renewal COC Request Review_20220916

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/14/2022 8:59:02 AM (COC Request Submission)
Submit by Georgoulias, Bethany A 9/16/2022 7:55:25 AM (Review COC Request for NCG140003)
* Verified owner and facility name are Childers Concrete Co in BIMS.
The task was assigned to Georgoulias, Bethany A. The due date is: September 19, 2022 5:00 PM
9/14/2022 8:59 AM

Permit COC Number* NCG140003
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.
What is incorrect? NEED TO OMIT: "Inc"
SHOULD READ: "Childers Concrete Company"
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 Mitchell Childers
Requesting COC* First and Last Name
Phone Number* 336-841-3111
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
S& Www
Date *
09/14/2022
Time
08:59:02 AM
Permittee *
Verify owner/operator is correct.
Childers Concrete Co
Facility Name*
Childers Concrete Co
Verify facility name is correct.

Address 200 Wise Ave
City High Point
County Guilford
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.
Richland 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.
Cape Fear
(Just the Basin name. Do not include the words 'River Basin")
COC Issuance Date*
9/16/2022
COC Effective Date*
9/16/2022
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.
Current owner and facility name (Childers Concrete Co) were verified in our
permitting database and corrected on the Certificate of Coverage (COC)
Document(s) to add
Documents that may be helpful to send requester (e.g., fees owed letter or BIMS screen shot).
to records
Owner and Facility Verification.JPG 78.31 KB
PDF or JPG allowed
Request Instance ID
105440
For request tracking purposes only.
Review Date*
9/16/2022