NCG210445_Renewal COC Request_20180830 12:44:29 PM

JI
Environmental
Quality
Permit COC
NCG210445
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 WTTH CARTAL "NO3'
Name of Person
Stephen Griffin
Obtaining COC*
First and Last Narre
Phone Number* 704-982-2516
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.
NCG210445
Permittee
Albemarle Wood Preserving Plan Inc
Facility Name
Albemarle Wood Preserving Plan, Inc.
Address
1509 Snuggs Park Rd
City
Albemarle
County
Stanly
Waterbody
Town Creek
Classification
C
River Basin
Yadkin
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 *
CJ ll9!G F*
Date * 08/30/2018