NCG210360_Renewal COC Request_20180906 2:10:00 PM

JI
Environmental
Quality
Permit COC
NCG210360
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the COC, not
NOW30000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
Willis Taylor
Obtaining COC*
First and Last Name
Phone Number*
7573282215
Email *
[e-mail]
The COCwill be e-mailed 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.
NCG210360
Permittee
CFT LLC
Facility Name
Carolina Bark Products
Address
RW 186 E
City
Seaboard
County
Northampton
Waterbody
Cypress Creek (Jordans Millpond)
Classification
QNSW
River Basin
Chowan
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 *
T16r
Date * 09/06/2018