NCG070044_Renewal COC Request_20200110 3:26:41 PM

NORTH C W Q-rA
EnHmnmertm! dafny
Permit COC
NCG070044
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
David C Bier
Obtaining COC*
First and Last Name
Phone Number* 7735062007
Email * [e-mail]
The COC w ill be e-nailed to this contact.
Additional Email [e-mail]
(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 [phone] or [e-mail].
M aste r Ge ne ral
NCG070000
Permit No.
COC No.
NCG070044
Permittee
Wilbert Burial Vault Co Inc
Facility Name
Wilbert Burial Vault Co
Address
1015 S Roberts Ave
City
Lumberton
County
Robeson
Waterbody
LUMBER RIVER
Classification
C;Sw
River Basin
Lumber
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