NCG050422_Renewal COC Request_20180621 2:25:34 PM

Envirnnmun tat
Quality
Permit COC
NCG050422
Number *
Enter the Certificate of Coverage (COC) number, not the General Rsnit nunber (e.g., NOG030222 is the OCC, not
NOG030000) MJST BEGIN WTTH CAPRAL "NCG'
Name of Person
Steve Brinchek
Obtaining COC*
First and LastNbrre
Phone Number*
919-209-2426
Email*
[e-mail]
The COCwill be e-mailed to this contact.
Additional Email
(Optional) Enter an additional enailaddress towhom tosend the OOC
Please review the information below for accuracy before submitting. If there are inconsistencies, please
contact Bethany Georgoulias at [phone] or [e-mail].
M aste r Ge ne ral
NCG050000
Permit No.
COC No.
NCG050422
Permittee
Opw- Fueling Containment Systems
Facility Name
OPW - Fueling Containment Systems
Address
3250 US Hwy 70 Business W
City
Smithfield
County
Johnston
Waterbody
Little Poplar Creek
Classification
WS-IV;NSW
River Basin
Neuse
RENEWAL STATUS
Active
Issuance Date*
05/31/2018
Effective Date
06/01/2018
1 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.
Signature *
Date * 06/21/2018