NCG060023_Renewal COC Request_20181212 11:19:57 AM

'rl n
NORTH CAFOLINA
Emlre -.1 Qd Wy
Permit COC
NCG060023
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 CAFTTAL "NCG'
Name of Person
Chris Harrington
Obtaining COC*
First and LastNarre
Phone Number* 704-296-4959
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.
NCG060023
Permittee
Tyson Farms Inc
Facility Name
Tyson Foods Inc - Monroe
Address
233 S Secrest Ave
City
Monroe
County
Union
Waterbody
Richardson 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
Date * 12/12/2018