NCG050394_Renewal COC Request_20180626 12:47:45 PM

JI
Environmental
Quality
Permit COC
NCG050394
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
Collin Breheny
Obtaining COC*
First and Last Name
Phone Number*
828-649-3114)0-16
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
NCG050000
Permit No.
COC No.
NCG050394
Permittee
Printpack Inc
Facility Name
PrintPack Inc.
Address
100 Kenpak Ln
City
Marshall
County
Madison
Waterbody
Profitt Branch
Classification
C
River Basin
French Broad
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 * 06/26/2018