NCG210446_Renewal COC Request_20201117 9:19:39 AM

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 11/17/2020 9:19:39 AM (COC Request Submission)

NORTH C W Q-rA
EnHmnmertm! dafny
Permit COC
Number*
Name of Person
Obtaining COC*
Phone Number*
NCG210446
Enter the Certificate of Coverage (COC) nun ber, not the General Rarnit nurrber (e.g., NOG030222 is the OOC, not
N00030000) M-ST BEGIN WTTH CARTAL "NCG'
Paul Shields
First and Last Narre
9197778803
Email* [e-mail]
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
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].
M aste r Ge ne ral
NCG210000
Permit No.
COC No.
NCG210446
Permittee
Goldston Lumber Inc
Facility Name
Goldston Lumber, Inc.
Address
2304 S Main St
City
Goldston
County
Chatham
Waterbody
Cedar Creek
Classification
C
River Basin
Cape Fear
RENEWAL STATUS
Active
Issuance Date*
07/31/2018
Effective Date
08/01/2018
Effective Date
20180801
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 * 11 /17/2020