NCG070036_Renewal COC Request_20180620 8:21:58 AM

JI
Environmental
Quality
Permit COC
NCG070036
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
Facility Name
NCG030000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
BRAD SHOAF
Obtaining COC*
First and Last Narre
Phone Number* 336-434-1815
Email * [e-mail]
The OOCw ill be e-rreiled to this contact.
Additional Email (Optional) Enter an additional enail 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].
M aste r Ge ne ral NCG070000
Permit No.
COC No.
NCG070036
Permittee
High Point Precast Inc
Facility Name
High Point Precast Incorporated
Address
9041 Hwy 311 S
City
Archdale
County
Randolph
Waterbody
Caraway Creek
Classification
C
River Basin
Yadkin
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 *
Date * 06/20/2018