NCG050253_Renewal COC Request_20180627 2:47:25 PM

Envirnnmun tat
Quality
Permit COC
NCG050253
Number *
Enter the Certificate of Coverage (COC) number, not the General Permit nunber (e.g., N0G030222 is the OCC, not
N00030000) MJST BEGIN WTTH CAPRAL "NO3'
Name of Person
Troy Brantley
Obtaining COC*
First and Last Nbrre
Phone Number*
[phone]
Email*
[e-mail]
The COCwill be e-mailed to this contact.
Additional Email
(Optional) Enter an additional email address towhom tosend the OOC
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.
NCG050253
Permittee
Mebchem Specialty Compounds Inc
Facility Name
Mexichem Specialty Compounds, Inc.
Address
9635 Industrial Dr
City
Pineville
County
Mecklenburg
Waterbody
Sugar Creek
Classification
C
River Basin
Catawba
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 * 06/27/2018