NCG210438_Renewal COC Request_20180905 12:22:50 PM

Environmental
Quality
Permit COC
NCG210438
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
COC No.
NCG030000) MUST BEGIN WTTH CARTAL "NO3'
Name of Person
lynn bell
Obtaining COC*
First and Last Name
Phone Number* 3366222266
Email * [e-mail]
The COCwill 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.
NCG210438
Permittee
Pallet Express Inc
Facility Name
Pallet Express, Inc.
Address
6306 Old 421 Rd
City
Liberty
County
Randolph
Waterbody
South Prong Stinking Quarter Creek
(Kimesville Lake)
Classification
WS-V,B;NSW
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 Storni Permit records.
Signature *
Date * 09/05/2018