NCG060030_Renewal COC Request_20181206 10:58:20 AM

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NORTH CAFOLINA
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Permit COC
Number*
Name of Person
Obtaining COC*
Phone Number*
NCG060030
Enter the Certificate of Coverage (OOC) number, not the General Fbrmt nunber (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAPITAL "NCG'
Corey Carpentier
First and Last Narre
828-756-6636
Email * [e-mail]
The COC will be e-rrailed to this contact.
Additional Email (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
NCG060000
Permit No.
COC No.
NCG060030
Permittee
Baxter Healthcare Corporation
Facility Name
Baxter Healthcare Corporation
Address
65 Pitts Sta Rd
City
Marion
County
McDowell
Waterbody
North Fork Catawba River and Stillhouse
Branch
Classification
B;Tr and C;Tr
River Basin
Catawba
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 *

Date * 12/06/2018