NCG110132_Renewal COC Request_20180625 2:17:40 PM

JI
Environmental
Quality
Permit COC
NCG110132
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
COC No.
NOW30000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
Blake Wright
Obtaining COC*
First and Last Narre
Phone Number* 828-428-5034
Email * [e-mail]
The COCwill be e-mailed to this contact.
Additional Email (Optional) Enter an additional enail 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.
NCG110132
Permittee
Town of Maiden
Facility Name
Maiden WWTP
Address
2090 W Finger St
City
Maiden
County
Catawba
Waterbody
Clark Creek (Shooks Lake)
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 *
01'me - vftr hr
Date * 06/25/2018