NCG170154_Renewal COC Request_20191021 8:17:56 AM

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Permit COC
NCG170154
Number *
Enter the Certificate of Coverage (COC) number, not the General Fbrmt number (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAPITAL "NCG'
Name of Person
Lisa Haynes
Obtaining COC*
First and LastNarra
Phone Number* 336-348-6516
Email * [e-mail]
The COC will be e-rrailed 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
NCG170000
Permit No.
COC No.
NCG170154
Permittee
Unifi Inc
Facility Name
Unifi Inc- Plant 21
Address
601 E Main Sreet
City
Yadkinville
County
Yadkin
Waterbody
North Deep Creek
Classification
C
River Basin
Yadkin
RENEWAL STATUS
Active
issuance Date*
08/01/2019
Effective Date
08/01/2019
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 * ti

Date * 10/21 /2019