NCG070160_Renewal COC Request_20180619 10:41:27 AM

JI
Environmental
Quality
Permit COC
NCG070160
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
Facility Name
NOW30000) MUST BEGIN WTTH CARTAL "NO3'
Name of Person
David Snyder
Obtaining COC*
First and Last Narre
Phone Number* 704-272-7677
Email * [e-mail]
The OOC will be e-mailed to this contact.
Additional Email (Optional) Enter an additional eneil address to whom to send the COC
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 NCG070000
Permit No.
COC No.
NCG070160
Permittee
The Quikrete Companies
Facility Name
The Quikrete Companies
Address
MNy 74 W
City
Peachland
County
Anson
Waterbody
Wide Mouth Branch
Classification
C
River Basin
Yadkin
RENEWAL STATUS
Active
Issuance Date*
05/31/2018
Effective Date
06/01/2018
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 *
Date * 06/19/2018