NCG070025_Renewal COC Request_20180713 3:29:38 PM

JI
Environmental
Quality
Permit COC
NCG070025
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
COC No.
NCG030000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
Linda Chirico
Obtaining COC*
First and Last Name
Phone Number* 704-279-2325
Email * [e-mail]
The OOCw ill be e-mailed to this contact.
Additional Email (Optional) Enter an additional eneil 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
NCG070000
Permit No.
COC No.
NCG070025
Permittee
Carolina Perlite Co
Facility Name
Carolina Perlite Co - Rowan Site
Address
14630 US Hwy 52 S
City
Gold Hill
County
Rowan
Waterbody
Long Creek and Riles 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 *
� rte. ��� �•��`�r. r�r�
Date * 07/13/2018