NCG030213_Renewal COC Request_20181127 9:13:46 AM

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NORTH CAFOLINA
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Permit COC
NCG030213
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
Ryan Cook
Obtaining COC*
First and LastNarra
Phone Number* 2523683060
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.
NCG030213
Permittee
Mitek Industries Inc
Facility Name
Mitek Edenton
Address
818 Soundside Rd
City
Edenton
County
Chowan
Waterbody
ALBEMARLE SOUND
Classification
SB
River Basin
Pasquotank
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 *
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Date * 11 /27/2018