NCG130082_Renewal COC Request_20180618 11:24:06 AM

JI
Environmental
Quality
Permit COC
NCG130082
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
NOW30000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
BARRY KROPELIN
Obtaining COC*
First and Last Narre
Phone Number*
704-238-9949
Email *
[e-mail]
The OOCw ill be e-rreiled to this contact.
Additional Email
[e-mail]
(Optional) Enter an additional email address to whom to send the COC
Please review the information below for accuracy before submitting. If there are inconsistencies, please
contact Bethany Georgoulias at [phone] or [e-mail].
Master General
NCG130000
Permit No.
COC No.
NCG130082
Permittee
Polyreps Inc
Facility Name
PolyReps, Inc.
Address
2501 Ashcraft Ave
City
Monroe
County
Union
Waterbody
Richardson Creek
Classification
C
River Basin
Yadkin
RENEWAL STATUS
Active
Issuance Date*
05/31/2018
Effective Date
06/01/2018
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 *
—61- ,[ r`Cip.0lr14
Date * 06/18/2018