NCG030459_Renewal COC Request_20181128 5:07:06 PM

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NORTH CAFOLINA
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Permit COC
NCG030459
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
Velton Jacobs
Obtaining COC*
First and LastNarra
Phone Number* 9106463011
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.
NCG030459
Permittee
The Council Tool Company
Facility Name
Council Tool Company - Lake Waccamaw
Address
345 Pecan Ln
City
Lake Waccamaw
County
Columbus
Waterbody
Lake Waccamaw
Classification
B;Sw,ORW
River Basin
Lumber
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