NCG060168_Renewal COC Request_20190124 2:00:23 PM

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NORTH CAFOLINA
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Permit COC
NCG060168
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 H Chapman Jr.
Obtaining COC*
First and LastNarre
Phone Number* 252-641-2308
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 NCG060000
Permit No.
COC No.
NCG060168
Permittee
Sara Lee Frozen Bakery LLC
Facility Name
Sara Lee Frozen Bakery, LLC
Address
110 Sara Lee Rd
City
Tarboro
County
Edgecombe
Waterbody
TAR RIVER
Classification
QNSW
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 *

Date * 01 /24/2019