NCG080868_Renewal COC Request_20181217 8:34:01 AM

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NORTH CAFOLINA
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Permit COC
NCG080868
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 CAFTTAL "NCG'
Name of Person
Brenden Rose
Obtaining COC*
First and LastNarre
Phone Number* 870-365-4087
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.
NCG080868
Permittee
Fedex Freight Inc
Facility Name
Fed Ex Freight, Inc - HKY
Address
2011 Fairgrove Church Rd
City
Newton
County
Catawba
Waterbody
Clark Creek (Shooks Lake)
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 * 12/17/2018