NCG120051_Renewal COC Request_20190430 12:32:37 PM

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NORTH CAFOLINA
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Permit COC
NCG120051
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
Mike Gurley
Obtaining COC*
First and LastNarra
Phone Number* 704-262-6019
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].
Master General NCG120000
Permit No.
COC No.
NCG120051
Permittee
Republic Services of North Carolina LLC
Facility Name
Republic Services of NC LLC - Mt. Gilead 2
Address
500 Landfill Rd
City
Mount Gilead
County
Montgomery
Waterbody
Rocky Creek (Rocky River)
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 *
r ie�y
Date * 04/30/2019