NCG210265_Renewal COC Request_20180907 1:23:00 PM

JI
Environmental
Quality
Permit COC
NCG210265
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the COC, not
NOW30000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
TRAVIS SHEPHERD
Obtaining COC*
First and Last Narre
Phone Number*
3368381101
Email *
[e-mail]
The COCwill be e-rreiled to this contact.
Additional Email
[e-mail]
(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].
Master General
NCG210000
Permit No.
COC No.
NCG210265
Permittee
High Country Lumber & Mulch
Facility Name
High Country Lumber and Mulch
Address
1461 Speedway Rd
City
North Wilkesboro
County
Wilkes
Waterbody
Fishing Creek
Classification
C
River Basin
Yadkin
RENEWAL STATUS
Active
Issuance Date*
07/31/2018
Effective Date
08/01/2018
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 * 09/07/2018