NCG030670_Renewal COC Request_20181217 11:48:16 AM

'rl n
NORTH CAFOLINA
Emlre -.1 Qd Wy
Permit COC
NCG030670
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
Nathan Eichinger
Obtaining COC*
First and LastNarre
Phone Number* 704-409-1617
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 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.
NCG030670
Permittee
Fontaine Modification Company
Facility Name
Fontaine Modification Company
Address
9827 Mount Holly Rd
City
Charlotte
County
Mecklenburg
Waterbody
Long Creek
Classification
WS-IV
River Basin
Catawba
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 * 12/17/2018