NCG030235_Renewal COC Request_20190319 11:54:16 AM

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NORTH CAFOLINA
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Permit COC
NCG030235
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
Michael McGuire
Obtaining COC*
First and LastNarra
Phone Number* 828-874-4111
Email * [e-mail]
The COC will be e-rrailed to this contact.
Additional Email jwA([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.
NCG030235
Permittee
Saft America Inc
Facility Name
Saft America Incorporated
Address
Crescent St
City
Valdese
County
Burke
Waterbody
Hoyle Creek and McGalliard Creek
Classification
WS-IV;CA
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
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Date * 03/19/2019