NCG050411_Renewal COC Request_20180622 2:38:50 PM

JI
Environmental
Quality
Permit COC
NCG050411
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
Jason Bryan
Obtaining COC*
First and Last Narre
Phone Number* 704-873-1488
Email * [e-mail]
The OOC will 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.
NCG050411
Permittee
Accuma Corp
Facility Name
Accuma Corp
Address
133 Fanjoy Rd
City
Statesville
County
Iredell
Waterbody
Fourth 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 *
r
0 dAlf t•
Date * 06/22/2018