NCG030309_Renewal COC Request_20181128 8:49:32 AM

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NORTH CAFOLINA
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Permit COC
NCG030309
Number *
Enter the Certificate of Coverage (OOC) number, not the General Fbrmt nurrber (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAPRAL "NCG'
Name of Person
Tavner Dixon
Obtaining COC*
First and LastNarra
Phone Number* 252-946-8081
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.
NCG030309
Permittee
Flanders Filters Inc
Facility Name
Flanders Filters Inc-Beauford County
Address
531 Flanders Filter Rd
City
Washington
County
Beaufort
Waterbody
Mitchell Branch
Classification
C;Sw,NSW
River Basin
Tar -Pamlico
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 /28/2018