NCG080399_Renewal COC Request_20181214 8:01:52 AM

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NORTH CAFOLINA
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Permit COC
NCG080399
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 CAPITAL "NCG'
Name of Person
BRENT KISER
Obtaining COC*
First and LastNarre
Phone Number* 828-464-7240
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 NCG080000
Permit No.
COC No.
NCG080399
Permittee
Sunbelt Furniture Xpress Inc
Facility Name
SunBelt Furniture Xpress LLC
Address
3255 20th Ave SE
City
Newton
County
Catawba
Waterbody
Clark Creek (Shooks Lake)
Classification
C
River Basin
Catawba
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 *
e,

Date * 12/14/2018