NCG100165_Renewal COC Request_20181129 3:30:45 PM

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NORTH CAFOLINA
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Permit COC
NCG100165
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 "NOG'
Name of Person
Kristyn Jacher
Obtaining COC*
First and LastNarre
Phone Number* 512-244-3631
Email * [e-mail]
The COC will be e-rrailed to this contact.
Additional Email [e-mail]
(Optional) Enter an additional erreil 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].
Master General NCG100000
Permit No.
COC No.
NCG100165
Permittee
Reid Stroud
Facility Name
R. Stroud's Inc.
Address
6118 Hwy 96 W
City
Youngsville
County
Franklin
Waterbody
Horse Creek
Classification
WS-V;NSW
River Basin
Neuse
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