NCG160015_Renewal COC Request_20191021 12:25:08 PM

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NORTH CAFOLINA
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Permit COC
NCG160015
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
Sean Mackey
Obtaining COC*
First and LastNarre
Phone Number* 4235717159
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].
Master General NCG160000
Permit No.
COC No.
NCG160015
Permittee
Maymead Materials
Facility Name
Jefferson Asphalt Plant
Address
180 Andy Fowler Rd
City
Jefferson
County
Ashe
Waterbody
Dog Creek
Classification
C;Tr:+
River Basin
New
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 * 10/21 /2019