NCG030582_Renewal COC Request_20181126 11:56:07 AM

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NORTH CAFOLINA
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Permit COC
NCG030582
Number *
Enter the Certificate of Coverage (GOC) number, not the General Fbrmt nurrber (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAPITAL "NCG'
Name of Person
Kenneth Gore
Obtaining COC*
First and LastNarre
Phone Number* 910-298-0136
Email * [e-mail]
The COC will be e-rrailed to this contact.
Additional Email (Optional) Enter an additional errail address to whom to send the CDC
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
NCG030000
Permit No.
COC No.
NCG030582
Permittee
Precision Hydraulic Cylinders Inc
Facility Name
Precision Hydraulic Cylinders - Wallace
Address
145 Southpark Dr
City
Wallace
County
Duplin
Waterbody
Island Creek
Classification
C;Sw
River Basin
Cape Fear
RENEWAL STATUS
Active
Issuance Date*
10/29/2018
Effective Date
11/01/2018
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 * 11 /26/2018