NCG070137_Renewal COC Request_20180809 2:18:53 PM

JI
Environmental
Quality
Permit COC
NCG070137
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the ODC, not
COC No.
NCG030000) MUST BEGIN WITH CARTAL "NCG'
Name of Person
Charles Hoffman
Obtaining COC*
First and Last Name
Phone Number* 8439083889
Email * [e-mail]
The COCwill 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
NCG070000
Permit No.
COC No.
NCG070137
Permittee
Fayblock Materials Inc
Facility Name
Fayblock Materials Incorporated
Address
130 Builders Blvd
City
Fayetteville
County
Cumberland
Waterbody
CAPE FEAR RIVER
Classification
C
River Basin
Cape Fear
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 *
OA�F'm�v �
Date * 08/09/2018