NCG160199_Renewal COC Request_20191029 2:59:57 PM

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Permit COC
NCG160199
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 CAFTTAL "NCG'
Name of Person
Mark Fortner
Obtaining COC*
First and LastNarra
Phone Number* 828-488-6298
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.
NCG160199
Permittee
Hmc Paving & Construction Co Inc
Facility Name
HMC Paving
Address
450 Industrial Park Blvd
City
Bryson City
County
Swain
Waterbody
Cochran Branch
Classification
C
River Basin
Little Tennessee
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 * 10/29/2019