NCG050350_Renewal COC Request_20180823 11:43:01 AM

Environmental
Quality
Permit COC
NCG050350
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
Jervey McGlothlin Jr
Obtaining COC*
First and Last Name
Phone Number*
336 474-1190
Email *
[e-mail]
The COCwill be e-rreiled to this contact.
Additional Email
jervey_1 @msn.com
(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
NCG050000
Permit No.
COC No.
NCG050350
Permittee
Imaflex USA Inc
Facility Name
Imaflex USA Inc.
Address
1200 Unity St
City
Thomasville
County
Davidson
Waterbody
Hanks Branch
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 *
r%� i'rc�i'rFlcrc.}
Date * 08/23/2018