NCG210449_Renewal COC Request_20180829 10:27:08 AM

JI
Environmental
Quality
Permit COC
NCG210449
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
Facility Name
NCG030000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
Wanda Clary
Obtaining COC*
First and Last Name
Phone Number* 252-257-3485
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 NCG210000
Permit No.
COC No.
NCG210449
Permittee
Elberta Crate & Box Company
Facility Name
Elberta Crate & Box Company
Address
147 Elberta Ln
City
Warrenton
County
Warren
Waterbody
Fishing Creek
Classification
QNSW
River Basin
Tar -Pamlico
RENEWAL STATUS
Active
Issuance Date*
07/31/2018
Effective Date
08/01/2018
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 * 08/29/2018