NCG050172_Renewal COC Request_20180724 9:03:14 AM

Envirnnmun tat
Quality
Permit COC
NCG050172
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
Kathryn Bowman
Obtaining COC*
First and Last Nbrre
Phone Number*
3367899161
Email*
[e-mail]
The COCwill be e-mailed to this contact.
Additional Email
(Optional) Enter an additional email address towhom tosend 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
NCG050000
Permit No.
COC No.
NCG050172
Permittee
Ncfi Polyurethanes
Facility Name
NCFI Polyurethanes
Address
511 Carter St
City
Mount Airy
County
Surry
Waterbody
Ararat River
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 *
r
Date * 07/24/2018