NCG070115_Renewal COC Request_20180913 11:15:28 AM

JI
Environmental
Quality
Permit COC
NCG070115
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 WITH 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.
NCG070115
Permittee
Adams an Oldcastle Company - Greensboro
Facility Name
Adams an Oldcastle Company
Address
108 Buchanan Church Rd
City
Greensboro
County
Guilford
Waterbody
Buffalo Creek
Classification
WS-V;NSW
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
Date * 09/13/2018