NCG080582_Renewal COC Request_20181226 11:01:08 AM

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NORTH CAFOLINA
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Permit COC
NCG080582
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
Perry Harrison
Obtaining COC*
First and LastNarre
Phone Number* 501-955-1316
Email * [e-mail]
The COC will be e-rrailed to this contact.
Additional Email [e-mail]
(Optional) Enter an additional erreil 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.
NCG080582
Permittee
Maverick Real Estate LLC
Facility Name
Maverick Specialized
Address
12801 Rocky Ford Rd
City
Laurinburg
County
Scotland
Waterbody
Leith Creek (Johns Pond)
Classification
C;Sw
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 * 12/26/2018