NCG030004_Renewal COC Request_20200427 4:58:58 PM

NORTH C W Q-rA
EnHmnmertm! dafny
Permit COC
NCG030004
Number *
Enter the Certificate of Coverage (COC) nun ber, not the General Rarnit nurrber (e.g., N00030222 is the OOC, not
NOG030000) M-ST BEGIN WTTH CARTAL "NOG'
Name of Person
LILY HANS
Obtaining COC*
First and Last Name
Phone Number* 7049165739
Email * LILY. HANS@CMWO RKS. COM
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
NCG030000
Permit No.
COC No.
NCG030004
Permittee
Duff -Norton
Facility Name
Duff -Norton
Address
9415 Pioneer Ave
City
Charlotte
County
Mecklenburg
Waterbody
Coffey Creek
Classification
C
River Basin
Catawba
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 *
f- ffcf

Date * 04/27/2020