NCG080166_Renewal COC Request_20190220 9:34:25 AM

'rl n
NORTH CAFOLINA
Emlre -.1 Qd Wy
Permit COC
NCG080166
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
Faron Leigh
Obtaining COC*
First and LastNarra
Phone Number* 336-669-7903
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.
NCG080166
Permittee
Colonial Pipeline Company Apex Delivery
Facility
Facility Name
Colonial Pipeline Co
Address
2216 Ten -Ten Rd
City
Apex
County
Wake
Waterbody
Middle Creek
Classification
QNSW
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 *

Date * 02/20/2019