NCG210361_Renewal COC Request_20180913 1:59:00 PM

JI
Environmental
Quality
Permit COC
NCG210361
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
NCG030000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
Tim Atchley
Obtaining COC*
First and Last Name
Phone Number*
828-245-0032
Email *
[e-mail]
The COCwill 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
NCG210000
Permit No.
COC No.
NCG210361
Permittee
Carpenter Design Inc
Facility Name
Carpenter Design Inc
Address
217 Belt Ct
City
Rutherfordton
County
Rutherford
Waterbody
Charles Creek
Classification
WS -IV
River Basin
Broad
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 * 09/13/2018