NCG170067_Renewal COC Request_20191023 4:48:47 PM

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Permit COC
NCG170067
Number *
Enter the Certificate of Coverage (COC) number, not the General Fbrmt number (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAFTTAL "NCG'
Name of Person
Amber Friday
Obtaining COC*
First and LastNarra
Phone Number* 704-951-2576
Email * [e-mail]
The COC will be e-rrailed to this contact.
Additional Email [e-mail]
(Optional) Enter an additional email address to whom to send the COC
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.
NCG170067
Permittee
American & Efird Inc
Facility Name
Gastonia 21
Address
1002 Jenkins Rd
City
Gastonia
County
Gaston
Waterbody
Crowders Creek
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 * 10/23/2019