NCG050426_Renewal COC Request_20200122 2:10:45 PM

NORTH C W Q-rA
EnHmnmertm! dafny
Permit COC
Number*
Name of Person
Obtaining COC*
Phone Number*
NCG050426
Enter the Certificate of Coverage (COC) nun ber, not the General Permit nurrber (e.g., NOG030222 is the OOC, not
N00030000) M-ST BEGIN WITH CARTAL "NCG'
Dena Vandenberg
First and Last Nacre
214-874-7217
Email * [e-mail]
The COC w ill be e-nailed to this contact.
Additional Email [e-mail]
(Optional) Enter an additional errail 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 NCG050000
Permit No.
COC No.
NCG050426
Permittee
Ennis Paint Inc
Facility Name
Ennis Paint, Inc.
Address
509 County Line Rd
City
Thomasville
County
Davidson
Waterbody
North Hamby Creek
Classification
C
River Basin
Yadkin
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 *
'.era%/ �dalpy

Date * 01 /22/2020