NCG030377_Renewal COC Request_20190208 11:44:12 AM

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Permit COC
NCG030377
Number *
Enter the Certificate of Coverage (COC) number, not the General Fbrmt number (e.g., NCGO30222 is the COC, not
NOG030000) M-ST BEGIN WTTH CAFTTAL "NCG'
Name of Person
Derek Wagoner
Obtaining COC*
First and LastNarre
Phone Number* 7046335384
Email * [e-mail]
The COC will be e-rrailed to this contact.
Additional Email [e-mail]
(Optional) Enter an additional email 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 NCG030000
Permit No.
COC No.
NCG030377
Permittee
Major Wire Screening Inc
Facility Name
Major Wire Screening Inc
Address
200 Peach Orchard Rd
City
Salisbury
County
Rowan
Waterbody
Town Creek
Classification
C
River Basin
Yadkin
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 * 02/08/2019