NCG130019_Renewal COC Request_20190515 10:59:02 AM

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Permit COC
NCG130019
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
Dell Golanski
Obtaining COC*
First and LastNarra
Phone Number* 281-923-2494
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 NCG130000
Permit No.
COC No.
NCG130019
Permittee
Strategic Materials Inc
Facility Name
Strategic Materials, Inc.
Address
503 Jct Rd
City
Durham
County
Durham
Waterbody
Ellerbe Creek
Classification
WS-V;NSW
River Basin
Neuse
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 *
Date * 05/15/2019