NCG060022_Renewal COC Request_20190402 11:38:50 AM

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Permit COC
NCG060022
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
Kevin
Obtaining COC*
First and LastNarra
Phone Number* Haynes
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
NCG060000
Permit No.
COC No.
NCG060022
Permittee
Tyson Farms Inc
Facility Name
Tyson Farms, Inc.
Address
501 Sheffield Rd
City
Harmony
County
Iredell
Waterbody
Hunting Creek
Classification
WS-III
River Basin
Yadkin
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 *
C-it ' `z°II a
Date * 04/02/2019