NCG070189_Renewal COC Request_20180821 11:56:06 AM

JI
Environmental
Quality
Permit COC
NCG070189
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
Kim Burton
Obtaining COC*
First and Last Name
Phone Number* 3364665309
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.
NCG070189
Permittee
Plycem USA Inc
Facility Name
Allura
Address
1149 Abtco Rd
City
North Wilkesboro
County
Wilkes
Waterbody
YADKIN RIVER
Classification
C
River Basin
Yadkin
RENEWAL STATUS
Active
Issuance Date *
07/25/2018
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 * 08/21/2018