NCG080865_Renewal COC Request_20190104 3:48:21 PM

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NORTH CAFOLINA
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Permit COC
NCG080865
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 CAFTTAL "NCG'
Name of Person
Sarah Karakitsos
Obtaining COC*
First and Last Nlarre
Phone Number* 919-286-5408
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.
NCG080865
Permittee
Couch Oil Company Of Durham
Facility Name
Couch Oil Company
Address
2907 Hillsborough Rd
City
Durham
County
Durham
Waterbody
Ellerbe Creek
Classification
WS-V;NSW
River Basin
Neuse
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 *
JAW w6tn
Date * 01 /04/2019