NCG060112_Renewal COC Request_20181129 2:55:46 PM

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NORTH CAFOLINA
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Permit COC
NCG060112
Number *
Enter the Certificate of Coverage (COC) number, not the General Fbrmt number (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAFTTAL "NCG'
Name of Person
Andrew Lucas
Obtaining COC*
First and LastNarre
Phone Number* 336-613-1665
Email * [e-mail]
The COC will be e-rrailed to this contact.
Additional Email [e-mail]
(Optional) Enter an additional errail 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
NCG060000
Permit No.
COC No.
NCG060112
Permittee
Millercoors LLC
Facility Name
MillerCoors LLC
Address
863 E Meadow Rd
City
Eden
County
Rockingham
Waterbody
Dry Creek
Classification
C
River Basin
Roanoke
RENEWAL STATUS
Active
issuance Date *
10/29/2018
Effective Date
11/01/2018
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 *
or
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Date * 11 /29/2018