NCG070198_Renewal COC Request_20180626 4:40:12 PM

JI
Environmental
Quality
Permit COC
NCG070198
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
NCG030000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
Bryant Clark
Obtaining COC*
First and Last Name
Phone Number*
704-483-2868
Email *
[e-mail]
The OOCw ill 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.
NCG070198
Permittee
Dellinger Precast Inc
Facility Name
Dellinger Precast
Address
4531 N Hwy 16
City
Denver
County
Lincoln
Waterbody
Killian Creek
Classification
C
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 Stormwater Permit records.
Signature *
ff,
Date * 06/26/2018