NCG050245_Renewal COC Request_20190102 4:46:29 PM

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NORTH CAFOLINA
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Permit COC
NCG050245
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 CAPRAL "NCG'
Name of Person
Tyler Miles
Obtaining COC*
First and LastNarra
Phone Number* 919-846-7492
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 NCG050000
Permit No.
COC No.
NCG050245
Permittee
J B S Associates LLC
Facility Name
JBS Associates - Leland
Address
150 Backhoe Rd
City
Leland
County
Brunswick
Waterbody
Jackeys Creek
Classification
C;Sw
River Basin
Cape Fear
RENEWAL STATUS
Active
Issuance Date*
05/31/2018
Effective Date
06/01/2018
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 * 01 /02/2019