NCG060063_Renewal COC Request_20181129 11:09:04 AM

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Permit COC
NCG060063
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 CAFTTAL "NCG'
Name of Person
Gary Bostic
Obtaining COC*
First and LastNarra
Phone Number* 8282022958
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 GOC
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 NCG060000
Permit No.
COC No.
NCG060063
Permittee
Valley Fine Foods Company Inc
Facility Name
Valley Fine Foods
Address
212 Nuway Parking Rd
City
Forest City
County
Rutherford
Waterbody
Second Broad River
Classification
WS-V
River Basin
Broad
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 /29/2018