NCG070071_Renewal COC Request_20211202 9:28:11 AM

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 12/2/2021 9:28:11 AM (COC Request Submission)

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Permit COC Number*
NCG070071
Enter the Certificate of Coverage (COC) number, not the General Permit number (e.g., NCG030222 is the COC,
not NCG030000) MUST BEGIN WITH CAPITAL "NCG"
Name of Person
David Cornelius
Obtaining COC*
First and Last Name
Phone Number*
[phone]
Email*
[e-mail]
The COC will be e-mailed to this contact.
Additional Email
[e-mail]
(Optional) Enter an additional email address to whom to send the COC
Did you check the permit COC file in our repository to ensure this COC was not already available from a previous
request? If it is, please
obtain it from there instead of this form.
* Yes, this COC was not already there.
Please review the information below for accuracy before submitting. If there are inconsistencies, please
contact Bethany Georgoulias at [phone] or [e-mail].
Master General
NCG070000
Permit No.
COC No.
NCG070071
Permittee
Permatech LLC
Facility Name
Permatech, LLC
Address
911 E Elm St
City
Graham
County
Alamance
Waterbody
HAW RIVER
Classification
WS-V;NSW
River Basin
Cape Fear
RENEWAL STATUS
Active
Issuance Date*
05/31/2018
Effective Date
06/01/2018
Effective Date
20180601
Reformatted

I 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.
In addition, I agree that submission of this form is a "transaction" subject to Chapter 66, Article 40 of the NC General
Statutes (the "Uniform Electronic Transactions Act"); and I agree to conduct this transaction by electronic means pursuant
to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
Signature*
Date * 12/02/2021