NCG170406_Renewal COC Request (Not Available)_20240823 1:49:46 PM

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NPDES Stormwater Renewal COC Request
09VII
Permit COC Number* NCG170406
Enter the Certificate of Coverage(COC)number.MUST BEGIN WITH CAPITAL"NCG"
Please review the information below for accuracy before submitting. If there are inconsistencies, please contact
[e-mail],or check the box below that says"permit information is incorrect".
Permittee* Kordsa Inc
Facility Name* KORDSA Laurel Hill
Address 17780 Armstrong Rd
City Laurel Hill
County Scotland
Name of Person Justin Jorgensen
Requesting COC* First and Last Name
Phone Number* 4233169404
Email* [e-mail]
The COC will be e-mailed to this contact.
Additional Email (Optional)Enter an additional email address to whom to send the COC
Master General Permit NCG170000
(MGP)
Issuance Date 05/29/2024
Master General Permit Issuance
Effective Date 06/01/2024
Master General Permit Effective
Please check permit information!
You can verify the most current COC facility information and renewal status by running this Permit Summary
Report(check the Permit Status at the top of the report). If the permit is expired,a renewal COC will not be
available.This may be because fees are owed.You can check for outstanding invoices at https:Hdeq.nc.gov/sw-
epayments.
Please send me a copy of the renewal COC.
I 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. If a COC is not available, I request a
follow-up from Stormwater Program staff.
In addition, I agree that submission of this form is a"transaction"subject to Chapter 66,Article 40 of the NC General
Statutes(the"Uniform Electronic Transactions Act");and I agree to conduct this transaction by electronic means pursuant
to Chapter 66,Article 40 of the NC General Statutes(the"Uniform Electronic Transactions Act").

Signature*
Date* 08/23/2024
Time 01:49:46 PM
If you do not receive an email with a copy of your renewal COC within a day,
please contact [e-mail]