NCG060230_Renewal COC Request_20181129 3:12:49 PM

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NORTH CAFOLINA
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Permit COC
NCG060230
Number *
Enter the Certificate of Coverage (OOC) number, not the General Fbrmt nurrber (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAPITAL "NCG'
Name of Person
Allen Robey
Obtaining COC*
First and LastNarra
Phone Number* 336-847-5061
Email * [e-mail]
The COC will be e-rrailed to this contact.
Additional Email (Optional) Enter an additional email address to whom to send the CDC
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
NCG060000
Permit No.
COC No.
NCG060230
Permittee
Innospec Active Chemicals LLC
Facility Name
Innospec Active Chemicals LLC
Address
775 Hackett St
City
Spencer
County
Rowan
Waterbody
YADKIN RIVER (including upper portion of
High Rock Lake below normal operating
level)
Classification
WS-V
River Basin
Yadkin
RENEWAL STATUS
Active
Issuance Date *
10/29/2018
Effective Date
11/01/2018
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 *
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Date * 11 /29/2018