NCG030596_Renewal COC Request_20190110 7:50:01 AM

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NORTH CAFOLINA
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Permit COC
NCG030596
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
Michael Shamp
Obtaining COC*
First and LastNarra
Phone Number* 704-644-5011
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.
NCG030596
Permittee
Controls Southeast Inc
Facility Name
Controls Southeast, Inc
Address
12201 Nations Ford Rd
City
Pineville
County
Mecklenburg
Waterbody
McCullough Branch
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 *
Date * 01 /10/2019