NCG060202_Renewal COC Request_20190826 2:31:15 PM

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NORTH CAFOLINA
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Permit COC
NCG060202
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
Hayley Jones
Obtaining COC*
First and LastNarra
Phone Number* 9102205492
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
NCG060000
Permit No.
COC No.
NCG060202
Permittee
N G Purvis Farms Inc
Facility Name
Bonlee Feed Mill
Address
3732 Old US Hwy 421 S
City
Bonlee
County
Chatham
Waterbody
Tick Creek
Classification
C
River Basin
Cape Fear
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 * 08/26/2019