NCG160032_Renewal COC Request_20200303 11:34:19 AM

NORTH C W Q-rA
EnHmnmertm! dafny
Permit COC
NCG160032
Number *
Enter the Certificate of Coverage (COC) nun ber, not the General Pen-rit nurrber (e.g., N00030222 is the ODC, not
NCG030000) M-ST BEGIN WTTH CARTAL "NCG'
Name of Person
Donald Mason
Obtaining COC*
First and Last Name
Phone Number* 8284210448
Email* [e-mail]
The COC w ill be e-nailed to this contact.
Additional Email [e-mail]
(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].
Master General
NCG160000
Permit No.
COC No.
NCG160032
Permittee
Harrison Division- Apac Tennesse Inc
Facility Name
Hayesville Asphalt Plant
Address
2062 McDonald Rd
City
Hayesville
County
Clay
Waterbody
Brasstown Creek
Classification
WS-IV
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 *
c ps` a%AW,

Date * 03/03/2020