NCG170129_Renewal COC Request_20191022 2:31:36 PM

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NORTH CAFOLINA
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Permit COC
NCG170129
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 CAPITAL "NCG'
Name of Person
Julie Spake
Obtaining COC*
First and LastNarra
Phone Number* 704-824-9961
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.
NCG170129
Permittee
Beal Manufacturing Inc
Facility Name
Beal Manufacturing, Inc.
Address
2403 Lowell Rd
City
Gastonia
County
Gaston
Waterbody
Housers Branch
Classification
C
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 * 10/22/2019