NCG110109_Renewal COC Request_20180620 9:33:10 AM

Environmental
Quality
Permit COC
NCG110109
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
NCG030000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
Patricia E Garrell
Obtaining COC*
First and Last Narre
Phone Number*
9106544148
Email *
[e-mail]
The OOCw ill be e -n -ailed to this contact.
Additional Email
[e-mail]
(Optional) Enter an additional email 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].
Master General
NCG110000
Permit No.
COC No.
NCG110109
Permittee
Town of Chadbourn
Facility Name
Chadbourn WWTP
Address
5275 Chadbourn Hwy
City
Chadbourn
County
Columbus
Waterbody
Peacock Branch
Classification
C;Sw
River Basin
Lumber
RENEWAL STATUS
Active
Issuance Date*
05/31/2018
Effective Date
06/01/2018
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 * 06/20/2018