NCG030689_Renewal COC Request_20190208 8:21:47 AM

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NORTH CAFOLINA
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Permit COC
NCG030689
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
Joe Beaman
Obtaining COC*
First and LastNarra
Phone Number* 9198483155
Email * [e-mail]
The COC will be e-rrailed to this contact.
Additional Email (Optional) Enter an additional errail 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
NCG030000
Permit No.
COC No.
NCG030689
Permittee
AwNorth Carolina
Facility Name
AW North Carolina
Address
4112 Old Oxford Hwy
City
Durham
County
Durham
Waterbody
NEUSE RIVER (Falls Lake below normal pool
elevation)
Classification
WS-IV;NSW,CA
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 *
01 ram 16&aw!

Date * 02/08/2019