NCG070147_Renewal COC Request_20180621 3:59:47 PM

JI
Environmental
Quality
Permit COC
NCG070147
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
COC No.
NOW30000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
Michelle Williams
Obtaining COC*
First and Last Narre
Phone Number* 704-489-0110
Email * [e-mail]
The COCwill be e -n -ailed to this contact.
Additional Email (Optional) Enter an additional enail 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.
NCG070147
Permittee
Dellinger Precast Inc
Facility Name
Dellinger Precast Inc.
Address
8151 Webbs Rd
City
Denver
County
Lincoln
Waterbody
CATAWBA RIVER (Lake Norman below
elevation 760)
Classification
WS-IV,B;CA
River Basin
Catawba
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 Storni Permit records.
Signature *
Date * 06/21/2018