NCG210256_Renewal COC Request_20180904 10:03:47 AM

JI
Environmental
Quality
Permit COC
NCG210256
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
NOW30000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
MIKE LYLES
Obtaining COC*
First and Last Narre
Phone Number*
828 584-0785
Email *
[e-mail]
The COCwill be e-mailed 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].
Master General
NCG210000
Permit No.
COC No.
NCG210256
Permittee
Brackett Brothers Corp
Facility Name
Brackett Brothers Corporation
Address
4875 Brackett Lyles Dr
City
Morganton
County
Burke
Waterbody
Silver Creek
Classification
C
River Basin
Catawba
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 * 09/04/2018