NCG030145_Renewal COC Request_20181126 12:37:21 PM

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NORTH CAFOLINA
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Permit COC
NCG030145
Number *
Enter the Certificate of Coverage (COC) number, not the General Fbrmt number (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAPITAL "NCG'
Name of Person
sammy clayton
Obtaining COC*
First and LastNarre
Phone Number* 9196307679
Email * [e-mail]
The COC will be e-rrailed 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].
M aste r Ge ne ral NCG030000
Permit No.
COC No.
NCG030145
Permittee
Newton Instrument Co Inc
Facility Name
Newton Instrument Co Incorporated
Address
111 E A St
City
Butner
County
Granville
Waterbody
Knap of Reeds Creek
Classification
WS-II;HQW,NSW
River Basin
Neuse
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