NCG210274_Renewal COC Request_20180830 10:43:47 AM

JI
Environmental
Quality
Permit COC
NCG210274
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the COC, not
COC No.
NOW30000) MUST BEGIN WTTH CARTAL "NO3'
Name of Person
MARSHA LAWS
Obtaining COC*
First and Last Name
Phone Number* 3367513501
Email * [e-mail]
The COCwill be e-mailed to this contact.
Additional Email (Optional) Enter an additional enail 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].
M aste r Ge ne ral
NCG210000
Permit No.
COC No.
NCG210274
Permittee
Funder America
Facility Name
Funder America/Peter Funder
Address
200 Funder Dr
City
Mocksville
County
Davie
Waterbody
Leonard Creek
Classification
C
River Basin
Yadkin
RENEWAL STATUS
Active
Issuance Date*
07/31/2018
Effective Date
08/01/2018
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 * 08/30/2018