NCG030286_Renewal COC Request_20181128 3:48:58 PM

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NORTH CAFOLINA
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Permit COC
NCG030286
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
CARMEN FERRUFINO
Obtaining COC*
First and LastNarra
Phone Number* 7042838171 EXT 226
Email * [e-mail]
The COC will be e-rrailed to this contact.
Additional Email (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.
NCG030286
Permittee
Vanguard Pailung LLC
Facility Name
Vanguard Supreme-Plt #1
Address
601 MacArthur Cir
City
Monroe
County
Union
Waterbody
Bearskin 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 *
G14IE.J F""TwlO
Date * 11 /28/2018