NCG030390_Renewal COC Request_20181206 1:41:02 PM

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Permit COC
NCG030390
Number *
Enter the Certificate of Coverage (0OC) number, not the General Fbrmt nurrber (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAPITAL "NCG'
Name of Person
Randy Reynolds
Obtaining COC*
First and LastNarre
Phone Number* 828-622-7500-ext207
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 GOC
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
NCG030000
Permit No.
COC No.
NCG030390
Permittee
Madison Manufacturing Co
Facility Name
Madison Manufacturing Co
Address
1 Madison Ave
City
Hot Springs
County
Madison
Waterbody
Spring Creek
Classification
C;Tr,ORW
River Basin
French Broad
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 * 12/06/2018