NCG180021_Renewal COC Request_20191025 4:51:36 PM

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NORTH CAFOLINA
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Permit COC
NCG180021
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
Karen McCoach
Obtaining COC*
First and LastNarre
Phone Number* 7174453237
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 NCG180000
Permit No.
COC No.
NCG180021
Permittee
Conestoga Wood Specialties Cor
Facility Name
Conestoga Wood Specialties Cor
Address
621 Johnston Pkwy
City
Kenly
County
Johnston
Waterbody
Little River (Tarpleys Pond)
Classification
WS-V;NSW
River Basin
Neuse
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 *
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Date * 10/25/2019