NCG180223_Renewal COC Request_20240624 12:15:28 PM

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NPDES Stormwater Renewal COC Request
09VII
Permit COC Number* NCG180223
Enter the Certificate of Coverage(COC)number.MUST BEGIN WITH CAPITAL"NCG"
Please review the information below for accuracy before submitting. If there are inconsistencies, please contact
[e-mail],or check the box below that says"permit information is incorrect".
Permittee* Ultracraft Company
Facility Name* Ultracraft Company
Address 6163 Old 421 Rd
City Liberty
County Randolph
Name of Person Delores A Green
Requesting COC* First and Last Name
Phone Number* 743-239-6688
Email* [e-mail]
The COC will be e-mailed to this contact.
Additional Email [e-mail]
(Optional)Enter an additional email address to whom to send the COC
Master General Permit NCG180000
(MGP)
Issuance Date 05/29/2024
Master General Permit Issuance
Effective Date 06/01/2024
Master General Permit Effective
Please check permit information!
You can verify the most current COC facility information and renewal status by running this Permit Summary
Report(check the Permit Status at the top of the report). If the permit is expired,a renewal COC will not be
available.This may be because fees are owed.You can check for outstanding invoices at https://deq.nc.gov/sw-
epayments.
Please send me a copy of the renewal COC.
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. If a COC is not available, I request a
follow-up from Stormwater Program staff.
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*
00WOW C"Ie t"Y
Date* 06/24/2024
Time 12:15:28 PM
If you do not receive an email with a copy of your renewal COC within a day,
please contact [e-mail]