NCG210012_Renewal COC Request_20180922 5:11:12 PM

JI
Environmental
Quality
Permit COC
NCG210012
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 WTTH CARTAL "NO3'
Name of Person
Charles Hedrick
Obtaining COC*
First and Last Narre
Phone Number* 336-746-5885
Email * [e-mail]
The OOCw ill be e-mailed to this contact.
Additional Email (Optional) Enter an additional eneil 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 NCG210000
Permit No.
COC No.
NCG210012
Permittee
Hedrick Bros Lumber Co Inc
Facility Name
Hedrick Bros Lumber Cc Incorporated
Address
Hwy 47
City
Lexington
County
Davidson
Waterbody
Fourmile Branch
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 *
0�
Date * 09/22/2018