NCG050002_Renewal COC Request_20180828 3:18:21 PM

JI
Environmental
Quality
Permit COC
NCG050002
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
NCG030000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
Anthony Chavis
Obtaining COC*
First and Last Name
Phone Number*
910 5575929
Email *
[e-mail]
The OOC will be e-mailed to this contact.
Additional Email
[e-mail]
(Optional) Enter an additional email 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].
Master General
NCG050000
Permit No.
COC No.
NCG050002
Permittee
Plastek Industries Inc
Facility Name
Plastek Industries, Inc.
Address
1015 County Home Rd
City
Hamlet
County
Richmond
Waterbody
Falling Creek (McDonalds Pond)
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 *
637e"re,X-nC,4.4ki1
Date * 08/28/2018