NCG050431_Renewal COC Request_20181218 1:38:56 PM

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NORTH CAFOLINA
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Permit COC
NCG050431
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
Martha Brown
Obtaining COC*
First and LastNarra
Phone Number* 800-331-8118
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 NCG050000
Permit No.
COC No.
NCG050431
Permittee
Ennis Flint
Facility Name
Ennis -Flint -Thomasville Facility
Address
115 Todd Ct
City
Thomasville
County
Davidson
Waterbody
North Hamby Creek
Classification
C
River Basin
Yadkin
RENEWAL STATUS
Active
Issuance Date*
05/31/2018
Effective Date
06/01/2018
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 * 12/18/2018