NCG210153_Renewal COC Request_20180904 2:03:02 PM

JI
Environmental
Quality
Permit COC
NCG210153
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
Don Isley
Obtaining COC*
First and Last Name
Phone Number* 336.333.5962
Email * [e-mail]
The COCwill be e-mailed to this contact.
Additional Email (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].
M aste r Ge ne ral
NCG210000
Permit No.
COC No.
NCG210153
Permittee
Industrial Wood Products Inc
Facility Name
Industrial Wood Products Inc
Address
9205 Hwy 22 N
City
Climax
County
Guilford
Waterbody
Little Polecat Creek
Classification
WS-III;HQW
River Basin
Cape Fear
RENEWAL STATUS
Active
Issuance Date*
07/31/2018
Effective Date
08/01/2018
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 *
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Date * 09/04/2018