NCG210363_Renewal COC Request_20180830 5:23:30 PM

JI
Environmental
Quality
Permit COC
NCG210363
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
COC No.
NOW30000) MUST BEGIN WTTH CARTAL "NO3'
Name of Person
David Davis
Obtaining COC*
First and Last Name
Phone Number* 540-484-6224
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
NCG210000
Permit No.
COC No.
NCG210363
Permittee
M W Manufacturers
Facility Name
M W Manufacturers
Address
408 Pine St
City
Fayetteville
County
Cumberland
Waterbody
Blounts Creek
Classification
C
River Basin
Cape Fear
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 *
ww ( . z
Date * 08/30/2018