NCG050243_Renewal COC Request_20180621 10:59:55 AM

Environmental
Quality
Permit COC
NCG050243
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
NCG030000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
Amy Trent
Obtaining COC*
First and Last Name
Phone Number*
3365781800
Email *
[e-mail]
The COCwill 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
NCG050000
Permit No.
COC No.
NCG050243
Permittee
Acucote Inc
Facility Name
Acucote Incorporated - Graham
Address
910 Elm St
City
Graham
County
Alamance
Waterbody
HAW RIVER
Classification
WS-V;NSW
River Basin
Cape Fear
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 *
�/ p� �
Date * 06/21/2018