NCG080980_Renewal COC Request Review_20220928

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/12/2022 9:50:05 AM (COC Request Submission)
Submit by Carson, Brittany D 9/28/2022 9:12:32 AM (Review COC Request for NCG080980)
• Georgoulias, Bethany A reassigned the task to Carson, Brittany D 9/13/2022 10:05 AM
This is the NCG08 that had the outfalls / receiving waterbody updated in BIMS the other day. They
* have requested an updated COC. You can generate a new COC by filling out updated information
Oust verify everything else is still accurate).
• The task was assigned to Georgoulias, Bethany A. The due date is: September 15, 2022 5:00 PM
9/12/2022 9:50 AM

Permit COC Number* NCG080980
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? receiving stream
Master General Permit NCG080000
Issuance Date*
06/30/2021
Master General Permit Issuance
Effective Date
07/01/2021
Master General Permit Effective
Name of Person
Alan Cabe
Requesting COC*
First and Last Name
Phone Number* 816-242-6278
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
Date * 09/12/2022
Time 09:50:05 AM
Permittee * Verify owner/operator is correct.
North Carolina Kenworth Inc
Facility Name* MHC Kenworth - Clinton
Verify facility name is correct.
Address 1103 N US 421 Hwy

City Clinton
County Sampson
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.
Williams Old Mill Branch
Waterbody
(e.g., WS-IV) List multiple classifications as they should read on the CDC.
Classification(s) *
C;Sw
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*
9/28/2022
COC Effective Date* 9/28/2022
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.
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 105144
For request tracking purposes only.
Review Date* 9/28/2022