NCG070140_Renewal COC Request_20180621 9:06:46 AM

Environmental
Quality
Permit COC
NCG070140
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 WITH CARTAL "NO3'
Name of Person
Steve Wyse
Obtaining COC*
First and Last Name
Phone Number* 423/282-4661
Email * [e-mail]
The COCwill 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
NCG070000
Permit No.
COC No.
NCG070140
Permittee
General Shale Brick Inc
Facility Name
General Shale Brick Inc -Cleveland County
Plant
Address
1622 Longbranch Rd
City
Grover
County
Cleveland
Waterbody
Jakes Branch
Classification
C
River Basin
Broad
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 Storni Permit records.
Signature *
W
Date * 06/21/2018