NCG050407_Renewal COC Request_20180723 3:58:19 PM

Environmental
Quality
Permit COC
NCG050407
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
Steve Hartzog
Obtaining COC*
First and Last Name
Phone Number*
9802582282
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
NCG050000
Permit No.
COC No.
NCG050407
Permittee
Wilbert Plastic Services
Facility Name
Wilbert Plastic Services
Address
1000 Oaks Pkwy
City
Belmont
County
Gaston
Waterbody
South Fork Catawba River
Classification
WS -V
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 *
a '.el-� 6 tC 7
Date * 07/23/2018