NCG070032_Renewal COC Request_20180619 11:21:44 AM

Environmental
Quality
Permit COC
NCG070032
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
NCG030000) MUST BEGIN WTTH CARTAL "NO3'
Name of Person
Dennis Shoaf
Obtaining COC*
First and Last Name
Phone Number*
336-787-5826
Email *
[e-mail]
The COCwill be e-mailed to this contact.
Additional Email
[e-mail]
(Optional) Enter an additional email 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].
Master General
NCG070000
Permit No.
COC No.
NCG070032
Permittee
Shoaf Precast Septic Tank Inc
Facility Name
Shoaf Precast Septic Tank Inc
Address
4130 US Hwy 64 W
City
Lexington
County
Davidson
Waterbody
Dykers Creek
Classification
WS -IV
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