NCG080838_Renewal COC Request_20190313 5:33:52 AM

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NORTH CAFOLINA
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Permit COC
NCG080838
Number *
Enter the Certificate of Coverage (COC) number, not the General Fbrmt number (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAPITAL "NCG'
Name of Person
Ben Speights
Obtaining COC*
First and LastNarra
Phone Number* 336-859-0902
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
NCG080000
Permit No.
COC No.
NCG080838
Permittee
J T Russell & Sons Inc
Facility Name
J T Russell & Sons Inc. -Healing Springs
Facility
Address
18846 NC Hwy 8
City
Denton
County
Davidson
Waterbody
Lick 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 * 03/13/2019