NCG080606_Renewal COC Request_20181212 1:18:42 PM

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NORTH CAFOLINA
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Permit COC
NCG080606
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 CAFTTAL "NCG'
Name of Person
Edward Cieszko
Obtaining COC*
First and LastNarre
Phone Number* 252-447-2096
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
NCG080000
Permit No.
COC No.
NCG080606
Permittee
Cieszko Construction Co Inc
Facility Name
Cieszko Construction Co Inc - Havelock
Address
249 Hwy 70 W
City
Havelock
County
Craven
Waterbody
Wolf Pit Branch
Classification
C;Sw,NSW
River Basin
Neuse
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 * 12/12/2018