NCG180227_Renewal COC Request_20191122 11:03:12 AM

NORTH C W Q-rA
EnHmnmertm! dafny
Permit COC
NCG180227
Number *
Enter the Certificate of Coverage (COC) nun ber, not the General Rarnit nurrber (e.g., N00030222 is the OOC, not
NCG030000) M-ST BEGIN WTTH CARTAL "NCG'
Name of Person
Larry Wright
Obtaining COC*
First and Last Name
Phone Number*
[phone]
Email *
[e-mail]
The COC w ill be e-nailed to this contact.
Additional Email
(Optional) Enter an additional email address towhom tosend the OOC
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.
NCG180227
Permittee
Kroehler Furniture Mfg Co Inc
Facility Name
Kroehler Furniture Mfg Co Inc
Address
1800 Conover Blvd
City
Conover
County
Catawba
Waterbody
Long 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 *
Date * 11 /22/2019