NCG120105_Renewal COC Request_20181127 1:59:29 PM

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Permit COC
NCG120105
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 CAPITAL "NCG'
Name of Person
ROBBY STONE
Obtaining COC*
First and LastNarra
Phone Number* 3368833217
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].
Master General NCG120000
Permit No.
COC No.
NCG120105
Permittee
City of High Point
Facility Name
Kersey Valley MSW Landfill
Address
3854 E Kivett Dr
City
High Point
County
Guilford
Waterbody
Richland Creek
Classification
WS-IV;CA:"
River Basin
Cape Fear
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 * 11 /27/2018