NCG050324_Renewal COC Request_20180627 9:06:49 AM

JI
Environmental
Quality
Permit COC
NCG050324
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
Facility Name
NOW30000) MUST BEGIN WTTH CARTAL "NO3'
Name of Person
Dean Chamis
Obtaining COC*
First and Last Narre
Phone Number* 704-730-1005
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 NCG050000
Permit No.
COC No.
NCG050324
Permittee
Blachford RP Corporation
Facility Name
Blachford RP Corporation
Address
707 Broadview Dr
City
Kings Mountain
County
Cleveland
Waterbody
Crowders Creek
Classification
C
River Basin
Catawba
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 *
elm! 6� e?lwl-y
Date * 06/27/2018