NCG070146_Renewal COC Request_20180712 4:02:34 PM

JI
Environmental
Quality
Permit COC
NCG070146
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
NOW30000) MUST BEGIN WTTH CARTAL "NO3'
Name of Person
Angela Shuford
Obtaining COC*
First and Last Name
Phone Number*
7047343503
Email *
[e-mail]
The COCwill 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
NCG070000
Permit No.
COC No.
NCG070146
Permittee
Imerys Mica Kings Mountain Inc
Facility Name
Imerys Mica Kings Mountain, Inc. -
Battleground
Address
1214 S Battleground Ave
City
Kings Mountain
County
Cleveland
Waterbody
Potts Creek (Pilot Branch)
Classification
C
River Basin
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 Storni Permit records.
Signature * Ape& 9�4

Date * 07/12/2018