NCG050019_Renewal COC Request_20180821 11:48:21 AM

JI
Environmental
Quality
Permit COC
NCG050019
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
Facility Name
NOW30000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
Wanda Mills
Obtaining COC*
First and Last Narre
Phone Number* 704-279-8363 ext 239
Email * [e-mail]
The OOC will 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 NCG050000
Permit No.
COC No.
NCG050019
Permittee
McKenzie Sports Products
Facility Name
McKenzie Ta>adermy Supplies
Address
1910 St Lukes Church Rd
City
Salisbury
County
Rowan
Waterbody
Church 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 Stormwater Permit records.
Signature *
Date * 08/21/2018