NCG050139_Renewal COC Request_20180926 1:10:09 PM

Envirnnmun tat
Quality
Permit COC
NCG050139
Number *
Enter the Certificate of Coverage (COC) number, not the General Rsnit number (e.g., NOG030222 is the OCC, not
N00030000) MBT BEGIN WTTH CAPRAL "NO3'
Name of Person
Tony Sain
Obtaining COC*
First and Last Name
Phone Number*
704-889-2431 ext 50204
Email*
[e-mail]
The COCwill be e-mailed to this contact.
Additional Email
(Optional) Enter an additional erailaddress 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.
NCG050139
Permittee
Ipex USA LLC
Facility Name
IPEX USA LLC
Address
10100 Rodney St
City
Pineville
County
Mecklenburg
Waterbody
Sugar Creek
Classification
C
River Basin
Catawba
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 *
f6"u
Date * 09/26/2018