NCG050370_Renewal COC Request_20180717 3:15:08 PM

JI
Environmental
Quality
Permit COC
NCG050370
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
TEDDY FAUST
Obtaining COC*
First and Last Narre
Phone Number* 7322723733
Email * [e-mail]
The COCwill be e -trailed 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.
NCG050370
Permittee
Innocor Foam Technologies - Acp Inc
Facility Name
Innocor Foam Technologies - ACP, Inc.
Address
2222 Surrett Dr
City
High Point
County
Randolph
Waterbody
Uwharrie River
Classification
WS -III
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 * 07/17/2018