NCG060065_Renewal COC Request_20181126 1:12:09 PM

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NORTH CAFOLINA
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Permit COC
NCG060065
Number *
Enter the Certificate of Coverage (GOC) number, not the General Fbrmt nurrber (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAPITAL "NCG'
Name of Person
Diane Gutierrez
Obtaining COC*
First and LastNarre
Phone Number* 972-364-2247
Email * Diane. [e-mail]
The COC will be e-rrailed to this contact.
Additional Email (Optional) Enter an additional email address to whom to send the CDC
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 NCG060000
Permit No.
COC No.
NCG060065
Permittee
McLane Foodservice Distribution Inc
Facility Name
McLance Salisbury
Address
40 Cir M Dr
City
Salisbury
County
Rowan
Waterbody
Grants Creek
Classification
C
River Basin
Yadkin
RENEWAL STATUS
Active
Issuance Date*
10/29/2018
Effective Date
11/01/2018
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 *
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Date * 11 /26/2018