NCG030560_Renewal COC Request_20181129 8:52:19 AM

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NORTH CAFOLINA
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Permit COC
NCG030560
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 CAPITAL "NCG'
Name of Person
David Gosselin
Obtaining COC*
First and LastNarre
Phone Number* 252-977-2720 x 544
Email * [e-mail]
The COCwill be e-rrailed to this contact.
Additional Email [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 NCG030000
Permit No.
COC No.
NCG030560
Permittee
Engine Systems Inc
Facility Name
Engine Systems Inc.
Address
175 Freight Rd
City
Rocky Mount
County
Nash
Waterbody
Stony Creek (Boddies Millpond)
Classification
QNSW
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

Date * 11 /29/2018