NCG090006_Renewal COC Request_20190115 3:21:36 PM

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Permit COC
NCG090006
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 CAPITAL "NCG'
Name of Person
Dave Haley
Obtaining COC*
First and LastNarra
Phone Number* 7048879450
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
NCG090000
Permit No.
COC No.
NCG090006
Permittee
Mallard Creek Polymers Inc
Facility Name
Mallard Creek Polymers Incorporated
Address
2800 Morehead Rd
City
Charlotte
County
Mecklenburg
Waterbody
Mallard Creek
Classification
C
River Basin
Yadkin
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 *
z"nao. �
Date * 01 /15/2019