NCG110078_Renewal COC Request_20180625 1:12:36 PM

JI
Environmental
Quality
Permit COC
NCG110078
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
Robert L Davis
Obtaining COC*
First and Last Narre
Phone Number*
919-603-1112
Email *
[e-mail]
The COCwill be e-mailed 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.
NCG110078
Permittee
City of Oxford
Facility Name
Oxford WWTP
Address
NCSR 1649
City
Oxford
County
Granville
Waterbody
Fishing Creek
Classification
QNSW
River Basin
Tar -Pamlico
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 *
"�PAKItrzow-W
Date * 06/25/2018