NCG180254_Renewal COC Request_20191203 9:29:40 AM

NORTH C W Q-rA
EnHmnmertm! dafny
Permit COC
NCG180254
Number *
Enter the Certificate of Coverage (COC) nun ber, not the General Pen-rit nurrber (e.g., N00030222 is the OOC, not
NCG030000) M-ST BEGIN WTTH CARTAL "NCG'
Name of Person
Bruce Braswell
Obtaining COC*
First and Last Name
Phone Number*
336-819-4035
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.
NCG180254
Permittee
Marsh Furniture Co
Facility Name
Marsh Furniture Co
Address
1001 S Centennial St
City
High Point
County
Guilford
Waterbody
Richland Creek
Classification
WS-IV: *
River Basin
Cape Fear
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 * 12/03/2019