NCG080786_Renewal COC Request_20181221 9:56:31 AM

'rl n
NORTH CAFOLINA
Emlre -.1 Qd Wy
Permit COC
NCG080786
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 CAPITAL "NCG'
Name of Person
Matt Einsmann
Obtaining COC*
First and Last Nlarre
Phone Number* 9193543227
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
NCG080000
Permit No.
COC No.
NCG080786
Permittee
Republic Services of North Carolina LLC
Facility Name
Republic Services of NC, LLC-GDS-
Washington
Address
450 Flanders Filter Rd
City
Washington
County
Beaufort
Waterbody
Mitchell Branch
Classification
C;Sw,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 *
444 r7F—W5 nhJ

Date * 12/21 /2018