NCG160152_Renewal COC Request_20191022 3:20:35 PM

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Permit COC
NCG160152
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
Don Mason
Obtaining COC*
First and LastNarra
Phone Number* 8284210448
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.
NCG160152
Permittee
Harrison Division - Apac Tenn Inc
Facility Name
Cherokee County Asphalt Plant
Address
235 Marrestop Rd
City
Murphy
County
Cherokee
Waterbody
Persimmon Creek (Lake Cherokee)
Classification
C
River Basin
Hiwassee
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 * 10/22/2019