NCG080819_Renewal COC Request_20181210 1:10:07 PM

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Permit COC
NCG080819
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
Zak Lokken
Obtaining COC*
First and LastNarre
Phone Number* 9197552446
Email * [e-mail]
The COC will 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 NCG080000
Permit No.
COC No.
NCG080819
Permittee
Sysco Food Services of Raleigh
Facility Name
Sysco Food Services of Raleigh
Address
1032 Baugh Rd
City
Selma
County
Johnston
Waterbody
Mill Creek (at Selma)
Classification
WS-IV;NSW
River Basin
Neuse
RENEWAL STATUS
Active
Issuance Date *
10/29/2018
Effective Date
11/01/2018
I 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 * 12/10/2018