NCG170401_Renewal COC Request_20191111 7:01:05 AM

NORTH C W Q-rA
EnHmnmertm! dafny
Permit COC
NCG170401
Number *
Enter the Certificate of Coverage (COC) nun ber, not the General Pen-rit nurrber (e.g., N00030222 is the OOC, not
NCG030000) M-ST BEGIN WTTH CARTAL "NCG'
Name of Person
Amy Conner
Obtaining COC*
First and Last Name
Phone Number*
2078761262
Email *
[e-mail]
The COC w ill be e-nailed to this contact.
Additional Email
(Optional) Enter an additional email address towhom tosend the OOC
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.
NCG170401
Permittee
Duvaltex US Inc
Facility Name
Duvaltex (US), Inc.
Address
304 E Main St
City
Elkin
County
Surry
Waterbody
YADKIN RIVER
Classification
C
River Basin
Yadkin
RENEWAL STATUS
Active
Issuance Date*
08/01/2019
Effective Date
08/01/2019
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.
Signature *
Date * 11 /11 /2019