NCG070180_Renewal COC Request_20190115 12:09:56 PM

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NORTH CAFOLINA
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Permit COC
NCG070180
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
Doug Fouts
Obtaining COC*
First and LastNarra
Phone Number* 3362759114
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
NCG070000
Permit No.
COC No.
NCG070180
Permittee
Adams an Oldcastle Company
Facility Name
Adams an Oldcastle Company
Address
192 Gateway Dr
City
Lemon Springs
County
Harnett
Waterbody
Black River (Little Black River) (Popes Lake,
Rhodes Pond)
Classification
C;Sw
River Basin
Cape Fear
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 * 01/15/2019