NCG050379_Renewal COC Request_20180621 3:30:08 PM

JI
Environmental
Quality
Permit COC
NCG050379
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
COC No.
NCG030000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
PAT HINTON
Obtaining COC*
First and Last Name
Phone Number* 252 826 4919
Email * PHINTON @ AIRBOSS.CA
The COCwill be e-mailed to this contact.
Additional Email (Optional) Enter an additional enail 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].
M aste r Ge ne ral
NCG050000
Permit No.
COC No.
NCG050379
Permittee
Air Boss Rubber Compounding
Facility Name
Air Boss Rubber Compounding
Address
500 Air Boss Pkwy
City
Scotland Neck
County
Halifax
Waterbody
Deep Creek
Classification
QNSW
River Basin
Tar -Pamlico
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 *
sz?le 4x4rGw
Date * 06/21/2018