NCG080749_Renewal COC Request_20181213 12:30:35 PM

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Permit COC
NCG080749
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
Debbie L Falls
Obtaining COC*
First and LastNarre
Phone Number* 7049277370
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.
NCG080749
Permittee
Rolling Frito-Lay Sales LP
Facility Name
Henderson Bins
Address
1980 NC 39 Hwy S
City
Henderson
County
Vance
Waterbody
Sandy Creek (Fox Reservoir, Roland Pond,
Club Pond, Weldons Mill Pond, Southerlands
Pond)
Classification
C;NSW:+
River Basin
Tar -Pamlico
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 * 12/13/2018