NCG030254_Renewal COC Request_20190103 2:40:13 PM

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NORTH CAFOLINA
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Permit COC
NCG030254
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
Arlen Padgett
Obtaining COC*
First and LastNarre
Phone Number* 7049215295
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.
NCG030254
Permittee
Spgprints America Inc
Facility Name
Stork Prints America, Inc.
Address
3201 Rotary Dr
City
Charlotte
County
Mecklenburg
Waterbody
Irwin Creek
Classification
C
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 *
a
Date * 01 /03/2019