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HomeMy WebLinkAboutNCG180072_Renewal COC Request_20191023 10:16:11 AM'rl n NORTH CAFOLINA Emlre -.1 Qd Wy Permit COC NCG180072 Number * Enter the Certificate of Coverage (OOC) number, not the General Fbrmt nurrber (e.g., NCGO30222 is the COC, not NCG030000) M-ST BEGIN WTTH CAPITAL "NCG' Name of Person Matt Jenkins Obtaining COC* First and LastNarra Phone Number* 828-428-9361 Email * matt.jenkins@ethanallen.com 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 (919) 707-3641 or bethany.georgoulias@ncdenr.gov. Master General NCG180000 Permit No. COC No. NCG180072 Permittee Ethan Allen Operations, Inc. Facility Name Ethan Allen Operations, Inc. Address 700 S Main Ave City Maiden County Catawba Waterbody Shady 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 * frrrLCz17'lc�.ris� Date * 10/23/2019