NCG050429_Renewal COC Request_20180702 7:10:25 AM

JI
Environmental
Quality
Permit COC
NCG050429
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
COC No.
NCG030000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
Tim Williams
Obtaining COC*
First and Last Narre
Phone Number* 3366617295
Email * [e-mail]
The COCwill be e-mailed to this contact.
Additional Email (Optional) Enter an additional enail 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
NCG050000
Permit No.
COC No.
NCG050429
Permittee
Westrock Converting Company
Facility Name
Westrock Converting Company
Address
5900-A Grassy Creek Blvd
City
Winston Salem
County
Forsyth
Waterbody
Grassy Creek
Classification
C
River Basin
Yadkin
RENEWAL STATUS
Active
Issuance Date*
05/31/2018
Effective Date
06/01/2018
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 *
zip "Vflll
Date * 07/02/2018