NCG180110_Renewal COC Request_20191028 3:15:09 PM

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NORTH CAFOLINA
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Permit COC
NCG180110
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 CAPITAL "NCG'
Name of Person
Lewis Herman
Obtaining COC*
First and LastNarra
Phone Number* 8283027119
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.
NCG180110
Permittee
Kincaid Furniture Co
Facility Name
Kincaid Furniture Co-Plants1&6
Address
Hwy 321 A
City
Hudson
County
Caldwell
Waterbody
Smoky Creek
Classification
WS-IV
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 *
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Date * 10/28/2019