NCG130024_Renewal COC Request_20180718 5:00:55 PM

JI
Environmental
Quality
Permit COC
NCG130024
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
COC No.
NOW30000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
Todd Blake
Obtaining COC*
First and Last Name
Phone Number* 336-644-0332
Email * [e-mail]
The OOC will be e-mailed to this contact.
Additional Email (Optional) Enter an additional enail address to whom to send the COC
Please review the information below for accuracy before submitting. If there are inconsistencies, please
contact Bethany Georgoulias at [phone] or [e-mail].
Master General
NCG130000
Permit No.
COC No.
NCG130024
Permittee
Safety-Kleen Systems Inc
Facility Name
Safety Kleen Corp -Robeson
Address
934 N 5th St
City
Saint Pauls
County
Robeson
Waterbody
Mercer Branch
Classification
C;Sw
River Basin
Lumber
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 *
U
Date * 07/18/2018