NCG210117_Renewal COC Request_20180924 9:59:46 AM

JI
Environmental
Quality
Permit COC
NCG210117
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
COC No.
NCG030000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
Stephen Butler
Obtaining COC*
First and Last Narre
Phone Number* [phone]
Email * [e-mail]
The OOC will 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.
NCG210117
Permittee
Boone Custom Forest Products
Facility Name
Boone Custom Forest Products
Address
467 Roby Greene Rd
City
Boone
County
Watauga
Waterbody
South Fork New River
Classification
C:+
River Basin
New
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 *
511th' 4C�ld{`
Date * 09/24/2018