NCG190075_Renewal COC Request_20201031 2:29:56 PM

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/31/2020 2:29:54 PM (COC Request Submission)

NORTH C W Q-rA
EnHmnmertm! dafny
Permit COC
NCG190075
Number *
Enter the Certificate of Coverage (COC) nun ber, not the General Penrit nurrber (e.g., N00030222 is the OOC, not
NCG030000) M-ST BEGIN WTTH CARTAL "NCG'
Name of Person
charles h Perry
Obtaining COC*
First and Last Name
Phone Number* 9104575488
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
Did you check the permit COC file in our repository to ensure this COC was not already available from a previous
request? If it is, please obtain it from there instead of this form.
V Yes, this COC was not already there.
Please review the information below for accuracy before submitting. If there are inconsistencies, please
contact Bethany Georgoulias at [phone] or [e-mail].
Master General NCG190000
Permit No.
COC No.
NCG190075
Permittee
The American Fish Company Inc
Facility Name
American Fish Company Boat & Metal Works
- Oak Island
Address
3600 Old Bridge Rd
City
Southport
County
Brunswick
Waterbody
Intracoastal Waterway
Classification
SA;HQW
River Basin
Cape Fear
RENEWAL STATUS
Active
Issuance Date*
10/01/2020
Effective Date
10/01/2020
Effective Date
20201001
Reformatted

I 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.
In addition, I agree that submission of this form is a "transaction" subject to Chapter 66, Article 40 of the NC General
Statutes (the "Uniform Electronic Transactions Act"); and I agree to conduct this transaction by electronic means
pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
Signature *
Date * 10/31 /2020