NCG160122_Renewal COC Request_20191114 9:07:39 AM

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Permit COC
NCG160122
Number *
Enter the Certificate of Coverage (COC) nun ber, not the General Pernit nurrber (e.g., N00030222 is the OOC, not
N00030000) M-ST BEGIN WTTH CARTAL "NCG'
Name of Person
Mark Cramer
Obtaining COC*
First and Last Name
Phone Number* 9196231833
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 NCG160000
Permit No.
COC No.
NCG160122
Permittee
APAC Atlantic Inc - Thompson -Arthur Div
Facility Name
Apac Atlantic Inc - Jamestown Plant (42510)
Address
5730 Riverdale Rd
City
Jamestown
County
Guilford
Waterbody
Copper Branch (Cooper Branch)
Classification
WS-IV:*
River Basin
Cape Fear
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 *

11/14/2019