NCG070085_Renewal COC Request_20200110 3:23:50 PM

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NORTH CAROLINA
Envtro ..1QuaNry
Permit COC
NCG070085
Number *
Enter the Certificate of Coverage (OOC) number, not the General Fbmit nunter (e.g., NOG030222 is the OOC, not
N03030000) M- ST BEGIN WTH CARTAL "NOG'
Name of Person
David C Bier
Obtaining COC*
First and LastNarre
Phone Number* 7736337509
Email * [e-mail]
The OOC will be e-nailed to this contact.
Additional Email [e-mail]
(Optional) Enter an additional erreil address to whom to send the OOC
Please review the information below for accuracy before submitting. If there are inconsistencies, please
contact Bethany Georgoulias at [phone] or [e-mail].
M aste r Ge ne ral NCG070000
Permit No.
COC No.
NCG070085
Permittee
Hairfield Wilbert Burial Vault
Facility Name
Hairfield Wilbert Burial Vault
Address
3098 Morganton Furniture
City
Morganton
County
Burke
Waterbody
McGalliard Creek
Classification
WS-IV
River Basin
Catawba
RENEWAL STATUS
Active
Issuance Date*
05/31/2018
Effective Date
06/01/2018
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 * 01 /10/2020