NCG050276_Renewal COC Request_20180927 7:45:38 AM

JI
Environmental
Quality
Permit COC
NCG050276
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
COC No.
NOW30000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
Jerry W. Eplin
Obtaining COC*
First and Last Name
Phone Number* 8282678212
Email * [e-mail]
The COCwill 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
NCG050000
Permit No.
COC No.
NCG050276
Permittee
Shurtape Technologies, LLC
Facility Name
Shurtape Tech Incorporated -Hudson
Address
220 Pleasant Hill Rd
City
Hudson
County
Caldwell
Waterbody
Gunpowder Creek (Old Mill Pond)
Classification
WS -IV
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
C%B�r� �� rCr4'.•
Date * 09/27/2018