NCG030563_Renewal COC Request_20181127 2:41:50 PM

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NORTH CAFOLINA
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Permit COC
NCG030563
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
Thad Rivers
Obtaining COC*
First and LastNarra
Phone Number* 704-636-5871
Email * [e-mail]
The COCw ill 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.
NCG030563
Permittee
Power Curbers Inc
Facility Name
Power Curbers, Inc.-Bendix Drive
Address
727 Bendix Dr
City
Salisbury
County
Rowan
Waterbody
Town Creek
Classification
C
River Basin
Yadkin
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 /27/2018