NCG170099_Renewal COC Request_20191028 10:54:24 AM

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Permit COC
Number*
Name of Person
Obtaining COC*
Phone Number*
NCG170099
Enter the Certificate of Coverage (GOC) number, not the General Fbrmt nunber (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAPITAL "NCG'
Greg Marana
First and Last Naas
8282474300
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 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.
NCG170099
Permittee
Milliken & Company
Facility Name
Milliken & Co -Golden Valley
Address
2080 NC Hwy 226
City
Bostic
County
Rutherford
Waterbody
First Broad River
Classification
WS-V;Tr
River Basin
Broad
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 * 10/28/2019