NCG030585_Renewal COC Request_20200203 10:38:45 AM

NORTH C W Q-rA
EnHmnmertm! dafny
Permit COC
NCG030585
Number *
Enter the Certificate of Coverage (COC) nun ber, not the General Pen-rit nurrber (e.g., N00030222 is the ODC, not
NCG030000) M-ST BEGIN WTTH CARTAL "NCG'
Name of Person
Alexandria Gardner
Obtaining COC*
First and Last Narre
Phone Number*
262-225-0910
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].
M aste r Ge ne ral
NCG030000
Permit No.
COC No.
NCG030585
Permittee
Berco of America
Facility Name
Berco of America
Address
615 Pegg Rd
City
Greensboro
County
Guilford
Waterbody
East Fork Deep River
Classification
WS-IV: *
River Basin
Cape Fear
RENEWAL STATUS
Active
Issuance Date*
10/29/2018
Effective Date
11/01/2018
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 *
fl�z'�rar�tr�r• �tt�tt�f.
Date * 02/03/2020