NCG030656_Renewal COC Request_20181203 3:10:00 PM

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NORTH CAFOLINA
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Permit COC
NCG030656
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
Keith Weaver
Obtaining COC*
First and LastNarra
Phone Number* 704 751 0629
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
NCG030000
Permit No.
COC No.
NCG030656
Permittee
Ksm Castings USA Inc
Facility Name
KSM Castings USA, Inc.
Address
120 Blue Brook Dr
City
Shelby
County
Cleveland
Waterbody
Beaverdam Creek
Classification
C
River Basin
Broad
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 * 12/03/2018