NCG080936_Renewal COC Request_20181218 10:15:04 AM

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NORTH CAFOLINA
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Permit COC
NCG080936
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
Karlan Kim Barthlow
Obtaining COC*
First and LastNarre
Phone Number* 770-964-4848
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.
NCG080936
Permittee
Trimac Transportation Inc
Facility Name
Trimac Transportation, Inc.
Address
190 Park Plaza Dr
City
Winston Salem
County
Forsyth
Waterbody
Leak Fork
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
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Date * 12/18/2018