NCG070149_Renewal COC Request_20180619 7:18:32 AM

Environmental
Quality
Permit COC
NCG070149
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
Joshua Martin
Obtaining COC*
First and Last Narre
Phone Number*
9195620031
Email *
[e-mail]
The OOC will be e-mailed 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
NCG070000
Permit No.
COC No.
NCG070149
Permittee
Imerys Perlite USA Inc
Facility Name
Imerys - Youngsville Plant
Address
100 Robert Blunt Dr
City
Youngsville
County
Franklin
Waterbody
Unnamed Tributary to Swift Creek
Classification
WS-III;NSW,CA
River Basin
Neuse
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 *
Date * 06/19/2018