NCG080430_Renewal COC Request_20181128 12:05:15 PM

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NORTH CAFOLINA
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Permit COC
NCG080430
Number *
Enter the Certificate of Coverage (COC) number, not the General Fbrmt number (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAFTTAL "NCG'
Name of Person
Jim Frei
Obtaining COC*
First and LastNarra
Phone Number* 919-661-9954
Email * [e-mail]
The COC will be e-rrailed to this contact.
Additional Email Cliff. [e-mail]
(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 NCG080000
Permit No.
COC No.
NCG080430
Permittee
Y R C Inc
Facility Name
YRC, Inc 671
Address
1255 NC Hwy 66 S
City
Kernersville
County
Forsyth
Waterbody
West Fork Deep River
Classification
WS-IV:'
River Basin
Cape Fear
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

Date * 11 /28/2018