NCG110056_Renewal COC Request_20180621 4:59:08 PM

Envirnnmun tat
Quality
Permit COC
NCG110056
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit nunber (e.g., N00030222 is the COC, not
N00030000) MJST BEGIN WTTH CAPRAL "NOG'
Name of Person
David Shellenbarger
Obtaining COC*
First and LastNarm
Phone Number*
704-842-5106
Email*
[e-mail]
The COCwill be e-mailed to this contact.
Additional Email
(Optional) Enter an additional errail address to whom to send the OOC
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.
NCG110056
Permittee
City of Gastonia
Facility Name
Long Creek WWTP
Address
3000 Old Spencer Mountain Rd
City
Dallas
County
Gaston
Waterbody
Long Creek
Classification
C
River Basin
Catawba
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 * 06/21/2018