NCG050418_Renewal COC Request_20181116 3:35:28 PM

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NORTH CAFOLINA
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Permit COC
NCG050418
Number *
Enter the Certificate of Coverage (COC) number, not the General Fbrmt number (e.g., NCGO30222 is the COC, not
COC No.
NCG030000) M -ST BEGIN WTTH CAFTTAL "NCG'
Name of Person
Britton Smith
Obtaining COC*
First and LastNbrra
Phone Number* 336469595
Email * [e-mail]
The COC will be e -nailed to this contact.
Additional Email [e-mail]
(Optional) Enter an additional errail 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.
NCG050418
Permittee
Lydall Thermal Acoustical Inc
Facility Name
Lydall Thermal Accostical, Inc - Yadkinville
Facility
Address
601 E Main St
City
Yadkinville
County
Yadkin
Waterbody
Town Branch
Classification
C
River Basin
Yadkin
RENEWAL STATUS
Active
Issuance Date*
11/05/2018
Effective Date
11/05/2018
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 * 11/16/2018