NCG210233_Renewal COC Request_20180830 1:06:05 PM

Environmental
Quality
Permit COC
NCG210233
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
NOW30000) MUST BEGIN WTTH CARTAL "NO3'
Name of Person
Randy Ayscue
Obtaining COC*
First and Last Name
Phone Number*
9196932225
Email *
[e-mail]
The COCwill be e-rreiled 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
NCG210000
Permit No.
COC No.
NCG210233
Permittee
Cmh Manufacturing Inc DBA Clayton Oxford
Facility Name
Clayton Oxford
Address
3212 Knotts Grove Rd
City
Oxford
County
Granville
Waterbody
Fishing Creek and Hachers Run
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 *
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Date * 08/30/2018