NCG170406_Renewal COC Request Review_20240626

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 6/21/2024 10:43:59 AM (COC Request Submission)
Submit by Joyce Sanford 6/26/2024 2:47:34 PM (Review COC Request for NCG170406)
• The task was assigned to bethany.georgoulias.The due date is:June 26,2024 5:00 PM
6/21/2024 10:44:03 AM
• bethany.georgoulias reassigned the task to Joyce Sanford 6/26/2024 9:46:49 AM
0 Please verify fees are paid and renew the COC in BIMS.

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NPDES Stormwater COC Renewal Request Review
09VII
Permit COC Number* NCG170406
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 or not available, but owed fees have been paid.
permit information on the COC is incorrect or old.
Master General Permit NCG170000
Issuance Date* 05/29/2024
Master General Permit Issuance
Effective Date 06/01/2024
Master General Permit Effective
Name of Person J. Miles Jorgensen
Requesting COC* First and Last Name
Phone Number* 423-643-2754
Email* [e-mail]
The COC will be e-mailed to this contact.
Additional Email (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* 06/21/2024
Time 10:43:59 AM
Permittee* Verify owner/operator is correct.
Kordsa Inc
Facility Name* KORDSA Laurel Hill
Verify facility name is correct.
Address 17780 Armstrong Rd
City Laurel Hill
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.
Gum Swamp Creek(Ida Mill 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* 6/26/2024
COC Effective Date* 6/26/2024
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 203273
For request tracking purposes only.
Review Date* 6/26/2024