NCG170026_Renewal COC Request_20191021 3:07:34 PM

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Permit COC
NCG170026
Number *
Enter the Certificate of Coverage (GOC) number, not the General Fbrmt nurrber (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAFTTAL "NCG'
Name of Person
Debra Jordan
Obtaining COC*
First and LastNarra
Phone Number* 7047352573
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 GOC
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.
NCG170026
Permittee
Fab Industries - Mohcian Mills Inc
Facility Name
Fab Industries -Mohican Mills Inc
Address
1419 Gaston St
City
Lincolnton
County
Lincoln
Waterbody
Lithia Branch (Boger Br.)
Classification
WS-IV
River Basin
Catawba
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 *
Date * 10/21 /2019