NCG140276_Renewal COC Request Review_20220930

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/30/2022 12:19:04 PM (COC Request Submission)
Submit by Carson, Brittany D 9/30/2022 1:51:14 PM (Review COC Request for NCG140276)
• Georgoulias, Bethany A reassigned the task to Carson, Brittany D 9/30/2022 1:18 PM
The task was assigned to Georgoulias, Bethany A. The due date is: October 5, 2022 5:00 PM
9/30/2022 12:19 PM

Permit COC Number* NCG140276
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
Amy Mateo
Requesting COC*
First and Last Name
Phone Number* 9102371791
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 * 09/30/2022
Time 12:19:04 PM
Permittee * Verify owner/operator is correct.
Concrete Service Company Inc
Facility Name* Concrete Service - Laurinburg
Verify facility name is correct.
Address 13820 Dixie Guarino Rd
City Laurinburg

County Scotland
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.
Leith Creek (Johns Pond)
Waterbody (e.g., WS-IV) List multiple classifications as they should read on the COC.
Classification(s)* C;Sw
River Basin(s) * Enter the name of the river basin(s) the receiving waters drain in.
Lumber
(Just the Basin name. Do not include the words 'River Basin")
COC Issuance Date* 9/30/2022
COC Effective Date* 9/30/2022
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.
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 108069
For request tracking purposes only.
Review Date* 9/30/2022