NCG210397_Renewal COC Request_20180920 3:04:33 PM

JI
Environmental
Quality
Permit COC
NCG210397
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
COC No.
NCG030000) MUST BEGIN WTTH CARTAL "NO3'
Name of Person
David Spruce
Obtaining COC*
First and Last Name
Phone Number* 3039093134
Email * [e-mail]
The OOCw ill be e-mailed to this contact.
Additional Email (Optional) Enter an additional eneil 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.
NCG210397
Permittee
Builders Firstsource
Facility Name
Builders Firstsource
Address
2100 Sterling Dr
City
Albemarle
County
Stanly
Waterbody
Jacobs Creek
Classification
WS -IV
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 *
Zr6k� r t
Date * 09/20/2018