NCG050376_Renewal COC Request_20180706 2:51:07 PM

JI
Environmental
Quality
Permit COC
NCG050376
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
COC No.
NOW30000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
Brandon Baertschi
Obtaining COC*
First and Last Narre
Phone Number* 815-618-8584
Email * [e-mail]
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.
NCG050376
Permittee
Upm Raflatac Inc
Facility Name
UPM-Raflatac Inc.
Address
400 Broad Point Rd
City
Mills River
County
Henderson
Waterbody
McDowell Creek
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 *
ot a,41el-I! ffal- 111 -1,r -
Date * 07/06/2018