NCG050419_Renewal COC Request_20181101 9:23:57 AM

JI
Environmental
Quality
Permit COC
NCG050419
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
NCG030000) MUST BEGIN WTTH CARTAL "NO3'
Name of Person
Britton Smith
Obtaining COC*
First and Last Narre
Phone Number*
336-466-9595
Email *
[e-mail]
The COCwill 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.
NCG050419
Permittee
Lydall Thermal Acoustical Inc
Facility Name
Lydall Thermal Acoustical Inc - Hamptonville
Facility
Address
1241 Buck Shoals Rd
City
Hamptonville
County
Yadkin
Waterbody
Rocky Branch
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 *

Date * 11/01/2018