NCG060359_Renewal COC Request_20181129 3:26:31 PM

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NORTH CAFOLINA
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Permit COC
NCG060359
Number *
Enter the Certificate of Coverage (OOC) number, not the General Fbrmt nurrber (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAPITAL "NCG'
Name of Person
Allen Robey
Obtaining COC*
First and LastNarra
Phone Number* 336-847-5061
Email * [e-mail]
The COC will be e-rrailed to this contact.
Additional Email (Optional) Enter an additional email address to whom to send the CDC
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
NCG060000
Permit No.
COC No.
NCG060359
Permittee
Innospec Active Chemicals LLC
Facility Name
Innospec Performance Chemicals
Address
510 W Grimes Ave
City
High Point
County
Guilford
Waterbody
Richland Creek
Classification
WS-IV:'
River Basin
Cape Fear
RENEWAL STATUS
Active
Issuance Date*
10/29/2018
Effective Date
11/01/2018
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 * 11 /29/2018