NCG170305_Renewal COC Request_20200226 3:00:25 PM

NORTH C W Q-rA
EnHmnmertm! dafny
Permit COC
NCG170305
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
Michael Harmon
Obtaining COC*
First and Last Name
Phone Number*
7047730175
Email*
[e-mail]
The COC w ill be e-nailed to this contact.
Additional Email
(Optional) Enter an additional enailaddress towhom tosend the CDC
Please review the information below for accuracy before submitting. If there are inconsistencies, please
contact Bethany Georgoulias at [phone] or [e-mail].
Master General
NCG170000
Permit No.
COC No.
NCG170305
Permittee
Cliffside Mills LLC
Facility Name
Cliffside Mills - PI 1
Address
Hwy 221 A
City
Cliffside
County
Rutherford
Waterbody
Second Broad River
Classification
WS-IV;CA
River Basin
Broad
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 *
�r-�rrzat�� t�-orr
Date * 02/26/2020