NCG050380_Renewal COC Request_20180815 8:26:41 AM

Envirnnmun tat
Quality
Permit COC
NCG050380
Number *
Enter the Certificate of Coverage (COC) number, not the General F ernit nunber (e.g., N0G030222 is the OCC, not
N0W30000) MJST BEGIN WTTH CAPRAL "NO3'
Name of Person
Glenn Rogers
Obtaining COC*
First and LastNbrre
Phone Number*
704-658-0186
Email*
[e-mail]
The COCwill be e -nailed 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.
NCG050380
Permittee
Pactiv LLC
Facility Name
Pactiv LLC - Mooresville Plant
Address
314 Mooresville Blvd
City
Mooresville
County
Iredell
Waterbody
Back Creek
Classification
WS-II;HQW
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 * 08/15/2018