NCG050003_Renewal COC Request_20190719 10:20:08 AM

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NORTH CAFOLINA
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Permit COC
NCG050003
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
David Jones
Obtaining COC*
First and LastNarra
Phone Number* 919-557-8606
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 GOC
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
NCG050000
Permit No.
COC No.
NCG050003
Permittee
Tyco Electronics Corporation
Facility Name
Tyco Electronics Corporation
Address
8000 Purfoy Rd
City
Fuquay Varina
County
Wake
Waterbody
Kenneth Creek
Classification
C
River Basin
Cape Fear
RENEWAL STATUS
Active
Issuance Date*
05/31/2018
Effective Date
06/01/2018
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 * 07/19/2019