NCG210430_Renewal COC Request_20180917 3:05:45 PM

Environmental
Quality
Permit COC
NCG210430
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
SUSAN HARRISON
Obtaining COC*
First and Last Name
Phone Number*
2527934045
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.
NCG210430
Permittee
Carolina Mat Inc
Facility Name
Carolina Mat Inc
Address
193 Hwy 149 N
City
Plymouth
County
Washington
Waterbody
Welch Creek
Classification
C;Sw
River Basin
Roanoke
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 * 09/17/2018