NCG080481_Renewal COC Request_20190208 3:27:09 PM

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NORTH CAFOLINA
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Permit COC
NCG080481
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
NCG080000
Permit No.
COC No.
NCG080481
Permittee
Shelba D Johnson Trucking Inc
Facility Name
Shelba Johnson Trucking Inc
Address
1640 Blair St
City
Thomasville
County
Davidson
Waterbody
Hunts Fork
Classification
C
River Basin
Yadkin
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 *
0 & PWXIor
Date * 02/08/2019