NCG210016_Renewal COC Request_20180912

Envirnnmun tat
Quality
Permit COC
NCG210016
Number *
Enter the Certificate of Coverage (COC) number, not the General Permit number (e.g., N00030222 is the COC, not
NOW30000) MBT BEGIN WTTH CAPRAL "NO3'
Name of Person
Randy Miller
Obtaining COC*
First and Last WTe
Phone Number*
336-973-7515
Email*
[e-mail]
The COCwill be e-mailed to this contact.
Additional Email
(Optional) Enter an additional errail address to whom to send the OOC
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
NCG210000
Permit No.
COC No.
NCG210016
Permittee
Randy D Miller Lumber Co
Facility Name
Randy D Miller Lumber Co
Address
538 N NC Hwy 16
City
Wilkesboro
County
Wilkes
Waterbody
Millers Creek
Classification
WS -IV
River Basin
Yadkin
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 * 09/12/2018