NCG170418_Renewal COC Request_20191113 8:37:05 AM

NORTH C W Q-rA
EnHmnmertm! dafny
Permit COC
Number*
Name of Person
Obtaining COC*
Phone Number*
NCG170418
Enter the Certificate of Coverage (COC) nun ber, not the General P n-rit nurrber (e.g., NOG030222 is the OOC, not
N00030000) M-ST BEGIN WTTH CARTAL "NCG'
Tyler Robinson
First and Last Nacre
704-768-0867
Email* [e-mail]
The COC w ill be e-nailed to this contact.
Additional Email [e-mail]
(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].
Master General NCG170000
Permit No.
COC No.
NCG170418
Permittee
Polymer Group Inc
Facility Name
Polymer Group
Address
111 Excellence Ln
City
Mooresville
County
Iredell
Waterbody
Back Creek
Classification
WS-II;HQW
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 *
2 'tmewd.w

Date * 11 /13/2019