NCG030516_Renewal COC Request_20190221 2:23:57 PM

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NORTH CAFOLINA
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Permit COC
NCG030516
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 CAFTTAL "NCG'
Name of Person
Lee Bradshaw
Obtaining COC*
First and LastNarra
Phone Number* 919 834-8027
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 NCG030000
Permit No.
COC No.
NCG030516
Permittee
Surtronics Inc
Facility Name
Surtronics Inc
Address
4001 Beryl Rd
City
Raleigh
County
Wake
Waterbody
Rocky Branch
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
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Date * 02/21 /2019