NCG080033_Renewal COC Request_20181210 4:26:57 PM

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NORTH CAFOLINA
Emlre -.1 Qd Wy
Permit COC
NCG080033
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
Fred Jordan
Obtaining COC*
First and LastNarra
Phone Number* 9106941171
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.
NCG080033
Permittee
Warren Oil Company Inc
Facility Name
Warren Oil Co -Dunn
Address
Hwy 301 N
City
Dunn
County
Harnett
Waterbody
Mingo Swamp
Classification
C;Sw
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 *
fitwj6041
Date * 12/10/2018