NCG070203_Renewal COC Request_20180913 11:14:17 AM

JI
Environmental
Quality
Permit COC
NCG070203
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 WTTH CARTAL "NO3'
Name of Person
Doug Fouts
Obtaining COC*
First and Last Name
Phone Number* 336 275-9114
Email * [e-mail]
The COCwill be e-mailed to this contact.
Additional Email (Optional) Enter an additional eneil 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
NCG070000
Permit No.
COC No.
NCG070203
Permittee
Old Castle Apg Inc DBA Adams
Facility Name
Adams - Charlotte/Reames Rd
Address
9950 Metromont Industrial Blvd
City
Charlotte
County
Mecklenburg
Waterbody
Dixon Branch
Classification
C
River Basin
Catawba
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 *
Date * 09/13/2018