NCG050412_Renewal COC Request_20180913 9:08:15 AM

Environmental
Quality
Permit COC
NCG050412
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
NCG030000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
JR Delk
Obtaining COC*
First and Last Name
Phone Number*
3364984175
Email *
[e-mail]
The COCwill be e-rreiled 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
NCG050000
Permit No.
COC No.
NCG050412
Permittee
Wellmark LLC
Facility Name
Wellmark LLC
Address
355 Waketa Dr
City
Asheboro
County
Randolph
Waterbody
Haskett Creek
Classification
C
River Basin
Cape Fear
RENEWAL STATUS
Active
Issuance Date*
05/31/2018
Effective Date
06/01/2018
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 *
FP ee;;f
Date * 09/13/2018