NCG200521_Renewal COC Request_20191112 11:57:57 AM

NORTH C W Q-rA
EnHmnmertm! dafny
Permit COC
NCG200521
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
Daniel Buwalda
Obtaining COC*
First and Last Name
Phone Number*
704-234-8614
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].
M aste r Ge ne ral
NCG200000
Permit No.
COC No.
NCG200521
Permittee
Keywell Metals LLC
Facility Name
Keywell Metals, LLC
Address
1035 Commercial Dr
City
Matthews
County
Union
Waterbody
South Fork Crooked 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 *
r'� lXw'
Date * 11 /12/2019