NCG050416_Renewal COC Request_20190108 4:08:21 PM

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NORTH CAFOLINA
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Permit COC
NCG050416
Number *
Enter the Certificate of Coverage (COC) number, not the General Fbrmt number (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAPITAL "NCG'
Name of Person
Megan Hawks
Obtaining COC*
First and LastNarra
Phone Number* 2767280201
Email * [e-mail]
The COC will be e-rrailed to this contact.
Additional Email [e-mail]
(Optional) Enter an additional email 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.
NCG050416
Permittee
New River Tire Recycling LLC
Facility Name
New River Tire Recycling LLC
Address
312 E Hwy 52 Bypass
City
Pilot Mtn
County
Surry
Waterbody
Chinquapin Creek
Classification
WS-II;HQW
River Basin
Yadkin
RENEWAL STATUS
Active
Issuance Date*
05/31/2018
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 * 01 /08/2019