NCG050082_Renewal COC Request_20180628 3:11:03 PM

JI
Environmental
Quality
Permit COC
NCG050082
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
Brian Lane
Obtaining COC*
First and Last Name
Phone Number* 828-459-8944
Email * [e-mail]
The OOCw ill 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
NCG050000
Permit No.
COC No.
NCG050082
Permittee
Certain Teed
Facility Name
Certain Teed- Claremont
Address
2651 Penny Rd
City
Claremont
County
Catawba
Waterbody
Long Creek
Classification
WS -IV
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
Date * 06/28/2018