NCG070189_Renewal COC Request_20181207 1:41:04 PM

'rl n
NORTH CAFOLINA
Emlre -.1 Qd Wy
Permit COC
NCG070189
Number *
Enter the Certificate of Coverage (GOC) number, not the General Fbrmt nurrber (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAFTTAL "NCG'
Name of Person
Kim Burton
Obtaining COC*
First and LastNbrra
Phone Number* 3364665309
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
NCG070000
Permit No.
COC No.
NCG070189
Permittee
Plycem USA Inc
Facility Name
Allura
Address
1149 Abtco Rd
City
North Wilkesboro
County
Wilkes
Waterbody
YADKIN RIVER
Classification
C
River Basin
Yadkin
RENEWAL STATUS
Active
Issuance Date*
07/25/2018
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 * 12/07/2018