NCG210434_Renewal COC Request_20181010 2:37:01 PM

JI
Environmental
Quality
Permit COC
NCG210434
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
Jeff Gerlock
Obtaining COC*
First and Last Name
Phone Number*
3363826849
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.
NCG210434
Permittee
Kepley -Frank Hardwood Co Inc
Facility Name
Kepley -Frank Hardwood Company, Inc.
Address
3979 Old Linwood Rd
City
Linwood
County
Davidson
Waterbody
Swearing Creek
Classification
C
River Basin
Yadkin
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 *
C -?11
Date * 10/10/2018