HomeMy WebLinkAboutNCG180255_Renewal COC Request_20191029 3:21:20 PM'rl n
NORTH CAFOLINA
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Permit COC
NCG180255
Number *
Enter the Certificate of Coverage (OOC) number, not the General Fbrmt nurrber (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAPITAL "NCG'
Name of Person
Nikki CUcina
Obtaining COC*
First and LastNarra
Phone Number* 828-584-0664
Email * ncucina@chaddockhome.com
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 (919) 707-3641 or bethany.georgoulias@ncdenr.gov.
Master General
NCG180000
Permit No.
COC No.
NCG180255
Permittee
Ferguson Copeland LLC DBA Chaddock
Home
Facility Name
Chaddock Home
Address
100 Reep Dr
City
Morganton
County
Burke
Waterbody
Little Silver 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 *
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Date * 10/29/2019