NCG120057_Renewal COC Request_20181127 3:55:42 PM

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Permit COC
NCG120057
Number *
Enter the Certificate of Coverage (GOC) number, not the General Fbrmt nurrber (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAPITAL "NCG'
Name of Person
Scott Hurley
Obtaining COC*
First and LastNarra
Phone Number* 336-846-3721
Email * [e-mail]
The COC will be e-rrailed to this contact.
Additional Email (Optional) Enter an additional email address to whom to send the CDC
Please review the information below for accuracy before submitting. If there are inconsistencies, please
contact Bethany Georgoulias at [phone] or [e-mail].
Master General
NCG120000
Permit No.
COC No.
NCG120057
Permittee
Ashe County Environmental Ser
Facility Name
Ashe County Environmental Ser
Address
739 Fred Pugh Rd
City
Crumpler
County
Ashe
Waterbody
North Fork New River and an unnamed
tributary to North Fork New River
Classification
C;ORW
River Basin
New
RENEWAL STATUS
Active
Issuance Date *
10/29/2018
Effective Date
11/01/2018
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 * 11 /27/2018