NCG070033_Renewal COC Request_20180718 1:38:04 PM

JI
Environmental
Quality
Permit COC
NCG070033
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
Facility Name
NOW30000) MUST BEGIN WTTH CARTAL "NO3'
Name of Person
David Mecimore
Obtaining COC*
First and Last Name
Phone Number* 828-632-4608
Email * [e-mail]
The COCwill be e-mailed to this contact.
Additional Email (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].
M aste r Ge ne ral NCG070000
Permit No.
COC No.
NCG070033
Permittee
Taylorsville Precast Molds Inc
Facility Name
Taylorsville Precast Molds Inc
Address
128 Taylorsville Mfg Rd
City
Taylorsville
County
Alexander
Waterbody
Jumping Run
Classification
WS -IV
River Basin
Catawba
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 * 07/18/2018