NCG160140_Renewal COC Request_20191018 2:51:32 PM

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Permit COC
NCG160140
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
Matt Davis
Obtaining COC*
First and LastNarre
Phone Number* 8288942778
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 GOC
Please review the information below for accuracy before submitting. If there are inconsistencies, please
contact Bethany Georgoulias at [phone] or [e-mail].
Master General NCG160000
Permit No.
COC No.
NCG160140
Permittee
D&S Asphalt Materials
Facility Name
D&S Asphalt Materials Inc
Address
265 Hugh Champion Rd
City
Tryon
County
Polk
Waterbody
Whiteoak Creek
Classification
C
River Basin
Broad
RENEWAL STATUS
Active
Issuance Date*
08/01/2019
Effective Date
08/01/2019
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 * 10/18/2019