NCG170388_Renewal COC Request_20191018 10:55:09 AM

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Permit COC
NCG170388
Number *
Enter the Certificate of Coverage (GOC) number, not the General Fbrmt nurrber (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WITH CAPRAL "NCG'
Name of Person
Tyler Miles
Obtaining COC*
First and LastNarra
Phone Number* 919-846-7492
Email * [e-mail]
The COC will be e-rrailed to this contact.
Additional Email (Optional) Enter an additional email address to whom to send the CDC
Please review the information below for accuracy before submitting. If there are inconsistencies, please
contact Bethany Georgoulias at [phone] or [e-mail].
Master General
NCG170000
Permit No.
COC No.
NCG170388
Permittee
Chambers Fabrics Inc
Facility Name
Chambers Fabrics Incorporated
Address
1914 S Elm St
City
High Point
County
Guilford
Waterbody
Richland Creek
Classification
C
River Basin
Cape Fear
RENEWAL STATUS
Active
Issuance Date*
08/01/2019
Effective Date
08/01/2019
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 *
9..
Date * 10/18/2019