NCG160017_Renewal COC Request_20200121 10:08:18 AM

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EnHmnmertm! dafny
Permit COC
NCG160017
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
Donald Mason
Obtaining COC*
First and Last Name
Phone Number* 8284210448
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.
NCG160017
Permittee
APAC Atlantic Inc
Facility Name
APAC Atlantic Inc - Rutherfordton
Address
1922 Maple Creek Rd
City
Rutherfordton
County
Rutherford
Waterbody
Mountain Creek
Classification
C
River Basin
Broad
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 *
cpW.�io

Date * 01 /21 /2020