NCG070166_Renewal COC Request_20180618 3:59:30 PM

Envirnnmun tat
Quality
Permit COC
NCG070166
Number *
Enter the Certificate of Coverage (COC) number, not the General Rsrrit number (e.g., NOG030222 is the COC, not
NOW30000) MBT BEGIN WTTH CAPRAL "NOG'
Name of Person
Jeff Lamm
Obtaining COC*
First and LastNarre
Phone Number*
828-253-6421
Email*
[e-mail]
The COCwill be e-mailed to this contact.
Additional Email
(Optional) Enter an additional erreiladdress towhom tosend the OOC
Please review the information below for accuracy before submitting. If there are inconsistencies, please
contact Bethany Georgoulias at [phone] or [e-mail].
M aste r Ge ne ral
NCG070000
Permit No.
COC No.
NCG070166
Permittee
Southern Concrete Materials Inc
Facility Name
Southern Concrete Materials - Precast
Address
250 Old Hendersonville Hwy
City
Fletcher
County
Henderson
Waterbody
Mud Creek
Classification
C
River Basin
French Broad
RENEWAL STATUS
Active
Issuance Date*
05/31/2018
Effective Date
06/01/2018
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- �
Date * 06/18/2018