HomeMy WebLinkAboutNCG050009_COMPLETE FILE - HISTORICAL_20130408STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
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DOC TYPE
HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑ ��� � � y (� . Y
YYYYMMDD
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Permit Coverage
z� Renewal Application -Form: ;
National Pollutant Discharge Elimination System Certificate of Coverage iNumfser
Stormwater General Permit NCG050000 NCG050009
The following Is the information currently In our database for•ybur facility., Please review this Wbrmatfori. carefully and make all. .
corrections/ additions a's necessary In the space provided to'the right of the current information,
OwnerAffiliation information*RelssveaPff7itltMYbemalledtothe0wneradt-ess.
.: Owner/ Organization -Name:. Blyth ktomescents International'
Owner Contact Steve: Gutkowsld
Mailing Address: 430 Gentry Rd - - -
Elkin, -NC 28621
Phone Number:. 336-835-6020 Fact
Fax Number:" 336-527-2294
E-mail address:' S �� a) M V i' (. -c,
Fadift Contact Infarmatlon
: Facllity.Name: BlythHomescents International M V P.Cronp , 4,
Facility Physical Address: . 430 Gentry Ln
Elkin, NC 28621
FacilityCantact:
-Mailing Address:• tA\/ i?'G-rvu P-I-
V_n
I j -Ne- ;I f�Cn I
Phone Number: -
Fax Number: -'52-1 —g.I
E-mail address: y'2A f za[3 �t� w �<_gt+� ��, oo t,),/p br.a rr�<, cc.—
Permit Contact jafbrnna kri
Permit Contact:' Douglas M Odell er� �,;fr, r �._
Mailing Address: 430 Gentry Rd Y�K•1• r• •.. ^_
Elkin, NC'- 28621
Phone Number:-910-527.-2201 Ext. 55G 7 5;._1
Fax Number: 336;527-2294 5-2-1 73 +1
E-mail address: WwUneoc r.ry ecZ mJp hrewnt. CaM:
Discharge Information
Receiving Stream: Yadkin River
Stream Class:' C - -
Basin: " Yadkin River Basin
Sub-Ba sin: 03-07-02.
'Nurnber'of Outfalls: .
_ ImnalredwaterslrMDL:'Does this faci€ity discharge to waters listed as impaired or waters with a flnallzed TMRL? ❑ Yes vo
(.Aac h2famaffm ar fhese uatarsrefarto h4u.17;1aenrstale.nc4vs/sa/1mpa1r&LWaters-77 L2V J
:.. Fadi ty(AdivU Changes : Please describe below.any changes to your facility or.activities since Issuance of.your permit -.Attached a' -
separate sheet if necessary. '
CEK117HCATION
I certify that I am familiar with the Worrhation contained in' the applicatian and that to the best of my knowledge and belief
such irifbrmation is true, comple nd accurate.
Signature Date
J4. to -
'Print or type name of person signing above Title.
SW General permit Coverage Renewal 0 j v�f
Please ri_turn this completed -renewal application foirOx): SiDrmiHater Aermitting ljnit j� rI JA
1617 Mai I. Service Center •----�
Raleigh; North Carolina 27699-1617
:.:P.R. �013'
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