NCG210017_Renewal COC Request_20190130 3:57:44 PM

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NORTH CAFOLINA
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Permit COC
NCG210017
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
Mark Delosreyes
Obtaining COC*
First and LastNarre
Phone Number* 2527712497
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 NCG210000
Permit No.
COC No.
NCG210017
Permittee
JW Jones Lumber Company Inc
Facility Name
J.W. Jones Lumber Company, Inc
Address
1443 Northside Rd
City
Elizabeth City
County
Pasquotank
Waterbody
Pasquotank River
Classification
WS-V;Sw
River Basin
Pasquotank
RENEWAL STATUS
Active
Issuance Date*
07/31/2018
Effective Date
08/01/2018
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 /30/2019