NCG050159_Renewal COC Request_20180628 10:33:23 AM

JI
Environmental
Quality
Permit COC
NCG050159
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
COC No.
NCG030000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
Terry Bass
Obtaining COC*
First and Last Name
Phone Number* 8165369605
Email * [e-mail]
The COCwill be e-mailed 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
NCG050000
Permit No.
COC No.
NCG050159
Permittee
Kroy Building Poducts Inc
Facility Name
Kroy Building Products - Fair Bluff
Address
15159 Andrew Jackson Hwy
City
Fair Bluff
County
Columbus
Waterbody
Heron Lakes
Classification
B;Sw
River Basin
Lumber
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 * 06/28/2018