NCG170009_Renewal COC Request_20191023 2:49:58 PM

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Permit COC
NCG170009
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
Dylan Shook
Obtaining COC*
First and LastNarra
Phone Number* 828-502-3253
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.
NCG170009
Permittee
Hanes Dye & Finishing Company
Facility Name
Hanes Dye & Finishing Company
Address
600 NW Blvd
City
Winston Salem
County
Forsyth
Waterbody
Peters Creek
Classification
C
River Basin
Yadkin
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 * 10/23/2019