NCG070007_Renewal COC Request_20180730 12:05:05 PM

JI
Environmental
Quality
Permit COC
NCG070007
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
NCG030000) MUST BEGIN WTTH CARTAL "NO3'
Name of Person
Rolland Waters
Obtaining COC*
First and Last Name
Phone Number*
9103185648
Email *
[e-mail]
The COCwill 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.
NCG070007
Permittee
Pilkington NA
Facility Name
Pilkington NA
Address
13121 S Rocky Ford Rd
City
Laurinburg
County
Scotland
Waterbody
Shoe Heel Creek (Big Shoe Heel Creek)
(Maxton Pond)
Classification
C;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 * 07/30/2018