NCG210155_Renewal COC Request_20180904 4:38:07 PM

Envirnnmun tat
Quality
Permit COC
NCG210155
Number *
Enter the Certificate of Coverage (COC) number, not the General Rsnit number (e.g., NOG030222 is the COC, not
NOG030000) MBT BEGIN WTTH CAPRAL "NO3'
Name of Person
John Coyle
Obtaining COC*
First and Last Narre
Phone Number*
910-439-8140
Email*
[e-mail]
The COCwill be e -Trailed 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.
NCG210155
Permittee
Jordan Lumber & Supply Inc
Facility Name
Jordan Lumber & Supply Incorporated
Address
Hwy 109 N
City
Mount Gilead
County
Montgomery
Waterbody
Clarks 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 *
Date * 09/04/2018