NCG210149_Renewal COC Request_20180831 4:10:21 PM

JI
Environmental
Quality
Permit COC
NCG210149
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 WITH CARTAL "NO3'
Name of Person
Joseph Mark
Obtaining COC*
First and Last Narre
Phone Number* [phone]
Email * [e-mail]
The OOC will be e-mailed to this contact.
Additional Email (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].
M aste r Ge ne ral
NCG210000
Permit No.
COC No.
NCG210149
Permittee
Ufp Mid Atlantic LLC
Facility Name
UFP Mid -Atlantic, LLC
Address
5631 D NC Hwy 62
City
Burlington
County
Alamance
Waterbody
Beaver Creek
Classification
WS-IV;NSW,CA
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 *
Joseph &-k
Date * 08/31/2018