NCG070202_Renewal COC Request_20180629 3:55:11 PM

Envirnnmun tat
Quality
Permit COC
NCG070202
Number *
Enter the Certificate of Coverage (COC) number, not the General Permit number (e.g., NOG030222 is the OCC, not
N00030000) MJST BEGIN WTTH CAPRAL "NCG'
Name of Person
Susan Sain
Obtaining COC*
First and LastNarre
Phone Number*
336-551-3902
Email*
[e-mail]
The COCwill be e-mailed to this contact.
Additional Email
(Optional) Enter an additional email address to whom to send 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
NCG070000
Permit No.
COC No.
NCG070202
Permittee
Pittsburg Glass Works LLC
Facility Name
Pittsburg Glass Works LLC
Address
300 Pgw Dr
City
Elkin
County
Surry
Waterbody
Turkey 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 *
Date * 06/29/2018