NCG080354_Renewal COC Request_20181217 5:03:17 PM

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NORTH CAFOLINA
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Permit COC
NCG080354
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
Jason Hedrick
Obtaining COC*
First and LastNarra
Phone Number* 828-725-6088
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].
M aste r Ge ne ral
NCG080000
Permit No.
COC No.
NCG080354
Permittee
Institution Food House Inc
Facility Name
Institution Food House Incorporated
Address
543 12th St Dr Nw
City
Hickory
County
Catawba
Waterbody
Frye Creek
Classification
WS-IV
River Basin
Catawba
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 *1/
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Date * 12/17/2018