NCG060354_Renewal COC Request_20181127 11:36:35 AM

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NORTH CAFOLINA
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Permit COC
Number*
Name of Person
Obtaining COC*
Phone Number*
NCG060354
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'
Mary Thomas
First and Last Narra
2529775967
Email * [e-mail]
The COC will be e-rrailed to this contact.
Additional Email (Optional) Enter an additional email 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].
M aste r Ge ne ral
NCG060000
Permit No.
COC No.
NCG060354
Permittee
Hospira, Inc.
Facility Name
Hospira - R1 & R2
Address
4285 N Wesleyan Blvd
City
Rocky Mount
County
Nash
Waterbody
Beech Branch
Classification
B;NSW
River Basin
Tar -Pamlico
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 *
m� 94c Wad
Date * 11 /27/2018