NCG070186_Renewal COC Request_20180814 9:48:24 AM

Environmental
Quality
Permit COC
NCG070186
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
NOW30000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
Geoffrey Roberson
Obtaining COC*
First and Last Name
Phone Number*
3365486007
Email *
[e-mail]
The OOC will be e-mailed 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
NCG070000
Permit No.
COC No.
NCG070186
Permittee
Pine Hall Brick Co
Facility Name
Pine Hall Brick Co. -Plant 5
Address
350 Teague Rd
City
Madison
County
Rockingham
Waterbody
DAN RIVER
Classification
WS -IV
River Basin
Roanoke
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 *
",few
Date * 08/14/2018