NCG070200_Renewal COC Request_20180712 3:29:29 PM

JI
Environmental
Quality
Permit COC
NCG070200
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 WTTH CARTAL "NO3'
Name of Person
David Andrews
Obtaining COC*
First and Last Name
Phone Number* 704-921-4940
Email * [e-mail]
The OOCw ill 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
NCG070000
Permit No.
COC No.
NCG070200
Permittee
Concord Terrazzco Company Inc
Facility Name
Concord Terrazzo Company Inc - Old
Concord Rd Yard
Address
10220 Old Concord Rd
City
Charlotte
County
Mecklenburg
Waterbody
Mallard Creek
Classification
C
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 Storni Permit records.
Signature *
J
Date * 07/12/2018