NCG120076_Renewal COC Request_20181128 1:49:38 PM

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Permit COC
NCG120076
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
Ricky Hawks
Obtaining COC*
First and LastNarra
Phone Number* 336-401-8375
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 CDC
Please review the information below for accuracy before submitting. If there are inconsistencies, please
contact Bethany Georgoulias at [phone] or [e-mail].
Master General
NCG120000
Permit No.
COC No.
NCG120076
Permittee
Surry County
Facility Name
Surry County Municipal Solid Waste Landfill
Address
237 Landfill Rd
City
Mount Airy
County
Surry
Waterbody
Ararat River and Stoney 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
Date * 11 /28/2018