NCG080841_Renewal COC Request_20181220 10:36:07 AM

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NORTH CAFOLINA
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Permit COC
NCG080841
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
John W. Culbreath
Obtaining COC*
First and LastNarre
Phone Number* 704-320-7777
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.
NCG080841
Permittee
Colonial Pipeline Company
Facility Name
Kannapolis Booster Station
Address
9301 Mooresville Rd
City
Concord
County
Cabarrus
Waterbody
Emerson Branch
Classification
WS-II;HQW
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 * 12/20/2018