NCG060036_Renewal COC Request_20181204 11:24:51 AM

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NORTH CAFOLINA
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Permit COC
NCG060036
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
Doug Burns - EHS
Obtaining COC*
First and LastNarre
Phone Number* 704 679-7127
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].
M aste r Ge ne ral NCG060000
Permit No.
COC No.
NCG060036
Permittee
Cargill Incorporated
Facility Name
Cargill Incorporated DCAR
Address
5000 South Blvd
City
Charlotte
County
Mecklenburg
Waterbody
Kings Branch and Little Sugar Creek
Classification
C
River Basin
Catawba
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 *
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Date * 12/04/2018