NCG160222_Renewal COC Request_20200303 11:53:44 AM

NORTH C W Q-rA
EnHmnmertm! dafny
Permit COC
NCG160222
Number *
Enter the Certificate of Coverage (COC) nun ber, not the General Pen-rit nurrber (e.g., N00030222 is the OOC, 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.
NCG160222
Permittee
Harrison Construction Company Division of
Apac Atlantic Inc
Facility Name
Harrison Spruce Pine Asphalt Plant
Address
396 Granite Ln
City
Bakersville
County
Mitchell
Waterbody
Bear Creek
Classification
C;Tr
River Basin
French 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 *
eA,-- -

Date * 03/03/2020