NCG060080_Renewal COC Request_20181205 11:36:26 AM

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Permit COC
NCG060080
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
Della Hasan
Obtaining COC*
First and LastNarre
Phone Number* 3367410869
Email * [e-mail]
The COC will be e-rrailed to this contact.
Additional Email HOPKINM1 @RJRT.com
(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 NCG060000
Permit No.
COC No.
NCG060080
Permittee
R J Reynolds Tobacco Company
Facility Name
Whitaker Park Operations
Address
1001 Reynolds Blvd
City
Winston Salem
County
Forsyth
Waterbody
Silas 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 *
0

Date * 12/05/2018